MEDICARE: DR. ERIC K GUPTA PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	52275	CA

General Provider Information

NPI Number	:	1114924776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC K GUPTA PHARM.D.

Provider Business Mailing Address
First Line	:	1029 PALM AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3012
Country	:	US
Telephone Number	:	909-469-5412
Fax Number	:	909-469-5539

Provider Business Practice Location Address
First Line	:	1029 PALM AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3012
Country	:	US
Telephone Number	:	909-469-5412
Fax Number	:	909-469-5539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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