MEDICARE: GURUDAS HAMPAPURAM

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	014293	KY

General Provider Information

NPI Number	:	1871124685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURUDAS HAMPAPURAM

Provider Business Mailing Address
First Line	:	423 PLEASANT RIDGE DR
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-3551
Country	:	US
Telephone Number	:	859-552-0749
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 W ALEX BELL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-1127
Country	:	US
Telephone Number	:	937-294-7210
Fax Number	:	937-294-7809

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	05/30/2026

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Directions to “ GURUDAS HAMPAPURAM ” Practice Location

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