Provider Demographics
NPI:1174805758
Name:UPSHAW, RHEBA JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:RHEBA
Middle Name:JEAN
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WHITCOMB ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2617
Mailing Address - Country:US
Mailing Address - Phone:219-944-9520
Mailing Address - Fax:
Practice Address - Street 1:720 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3222
Practice Address - Country:US
Practice Address - Phone:219-397-6208
Practice Address - Fax:219-378-1330
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020572A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist