Provider Demographics
NPI:1871937425
Name:GUPTA, SHIKHA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHIKHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:SHIKHA
Other - Middle Name:
Other - Last Name:AGARWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15272 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0231
Mailing Address - Country:US
Mailing Address - Phone:909-646-7231
Mailing Address - Fax:
Practice Address - Street 1:15272 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0231
Practice Address - Country:US
Practice Address - Phone:909-646-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist