Provider Demographics
NPI:1811234024
Name:GUPTA, PRIYANKA
Entity Type:Individual
Prefix:MRS
First Name:PRIYANKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 OAKS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9421
Mailing Address - Country:US
Mailing Address - Phone:941-727-4543
Mailing Address - Fax:
Practice Address - Street 1:692 OAKS CREEK CT
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9421
Practice Address - Country:US
Practice Address - Phone:941-727-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist