Healthcare Provider Details

I. General information

NPI: 1871124685
Provider Name (Legal Business Name): GURUDAS HAMPAPURAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 W ALEX BELL RD
DAYTON OH
45459-1127
US

IV. Provider business mailing address

423 PLEASANT RIDGE DR
LEBANON OH
45036-3551
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-7210
  • Fax: 937-294-7809
Mailing address:
  • Phone: 859-552-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number014293
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: