=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831576743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & A GUPTA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2015
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25444 STATE ROAD 46 SUITE #3
-----------------------------------------------------
City | SORRENTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-720-3104
-----------------------------------------------------
Fax | 352-729-9736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25444 STATE ROAD 46 STE 3
-----------------------------------------------------
City | SORRENTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32776-8101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-720-3104
-----------------------------------------------------
Fax | 352-729-6736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. SHOBHIT GUPTA
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 352-720-3104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | PH27247
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH27247
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------