Provider Demographics
NPI:1457767337
Name:LUPTON, KURT
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:LUPTON
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 1:223 N MYRTLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1257
Mailing Address - Country:US
Mailing Address - Phone:704-864-6660
Mailing Address - Fax:
Practice Address - Street 1:223 N MYRTLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1257
Practice Address - Country:US
Practice Address - Phone:704-864-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17072183500000X
SC11194183500000X
OH03225073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist