Provider Demographics
NPI:1902353279
Name:GUPTA, VINEET (RPH, PHD)
Entity Type:Individual
Prefix:
First Name:VINEET
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 KEMP BLVD
Mailing Address - Street 2:APT 1101
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1063
Mailing Address - Country:US
Mailing Address - Phone:216-802-8897
Mailing Address - Fax:
Practice Address - Street 1:4600 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1466
Practice Address - Country:US
Practice Address - Phone:940-692-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-04
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57780183500000X
AZS021828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist