Provider Demographics
NPI:1609545946
Name:GUPTA, NITESH
Entity Type:Individual
Prefix:
First Name:NITESH
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MALABAR RD SE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3252
Mailing Address - Country:US
Mailing Address - Phone:407-773-4013
Mailing Address - Fax:877-232-9689
Practice Address - Street 1:930 MALABAR RD SE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3252
Practice Address - Country:US
Practice Address - Phone:407-773-4013
Practice Address - Fax:877-232-9689
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist