Provider Demographics
NPI:1063683084
Name:GUPTA, SHALU (PHARMD, BCOP)
Entity Type:Individual
Prefix:
First Name:SHALU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 LOTUS LN
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-9598
Mailing Address - Country:US
Mailing Address - Phone:610-417-9913
Mailing Address - Fax:570-300-1791
Practice Address - Street 1:4255 LOTUS LN
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-9598
Practice Address - Country:US
Practice Address - Phone:610-417-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist