Provider Demographics
NPI:1366567604
Name:MUTHA, NUPUR PARESH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:NUPUR
Middle Name:PARESH
Last Name:MUTHA
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 1:10923 WILKLEE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:919-225-5675
Mailing Address - Fax:
Practice Address - Street 1:210 EAST TRADE ST. E-186
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:704-971-1254
Practice Address - Fax:704-971-7537
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021929183500000X
NC22179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist