Provider Demographics
NPI:1316290570
Name:GUPTA, REEMA
Entity type:Individual
Prefix:
First Name:REEMA
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 1:1865 N NATIONAL RD # 17029
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5194
Mailing Address - Country:US
Mailing Address - Phone:812-376-6938
Mailing Address - Fax:812-314-7647
Practice Address - Street 1:1865 N NATIONAL RD
Practice Address - Street 2:T01911
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5194
Practice Address - Country:US
Practice Address - Phone:812-376-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024440A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist