Provider Demographics
NPI:1851704019
Name:UPPAL, UMSA
Entity Type:Individual
Prefix:
First Name:UMSA
Middle Name:
Last Name:UPPAL
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 1:803 ARCHER PL
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2713
Mailing Address - Country:US
Mailing Address - Phone:302-897-7434
Mailing Address - Fax:
Practice Address - Street 1:66 E GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1002
Practice Address - Country:US
Practice Address - Phone:302-897-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist