Provider Demographics
NPI:1346590940
Name:GUPTA, ANKUR KUMAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 11 MILE RD APT 21
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2746
Mailing Address - Country:US
Mailing Address - Phone:313-544-0708
Mailing Address - Fax:
Practice Address - Street 1:333 E 11 MILE RD APT 21
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2746
Practice Address - Country:US
Practice Address - Phone:313-544-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist