Healthcare Provider Details

I. General information

NPI: 1487949293
Provider Name (Legal Business Name): RAINA E GUPTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 PUTNEY RD SUITE 6
BRATTLEBORO VT
05301-7169
US

IV. Provider business mailing address

907 VERMONT ROUTE 30
NEWFANE VT
05345-9655
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-1051
  • Fax:
Mailing address:
  • Phone: 802-365-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0003621
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: