Provider Demographics
NPI:1871124685
Name:HAMPAPURAM, GURUDAS
Entity type:Individual
Prefix:
First Name:GURUDAS
Middle Name:
Last Name:HAMPAPURAM
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 1:1721 IRON LOOP PATH
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8098
Mailing Address - Country:US
Mailing Address - Phone:859-552-0749
Mailing Address - Fax:
Practice Address - Street 1:106 MARKET PLACE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-7400
Practice Address - Country:US
Practice Address - Phone:859-552-0749
Practice Address - Fax:859-317-6079
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0142931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist