Healthcare Provider Details

I. General information

NPI: 1063683084
Provider Name (Legal Business Name): SHALU GUPTA PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 LOTUS LN
COOPERSBURG PA
18036-9598
US

IV. Provider business mailing address

4255 LOTUS LN
COOPERSBURG PA
18036-9598
US

V. Phone/Fax

Practice location:
  • Phone: 610-417-9913
  • Fax:
Mailing address:
  • Phone: 610-417-9913
  • Fax: 570-300-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439999
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: