Provider Demographics
NPI:1073647012
Name:GUPTA, LAYAK RAM (RPH)
Entity Type:Individual
Prefix:
First Name:LAYAK
Middle Name:RAM
Last Name:GUPTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1705
Mailing Address - Country:US
Mailing Address - Phone:973-694-7020
Mailing Address - Fax:201-568-9226
Practice Address - Street 1:543 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-568-9378
Practice Address - Fax:201-568-9226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01593200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01593200OtherPHARMACIST LICENSE NO