Provider Demographics
NPI:1487949293
Name:GUPTON, RAINA E (PHARMD)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:E
Last Name:GUPTON
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 1:907 VERMONT ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:VT
Mailing Address - Zip Code:05345-9655
Mailing Address - Country:US
Mailing Address - Phone:802-365-9885
Mailing Address - Fax:
Practice Address - Street 1:896 PUTNEY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7169
Practice Address - Country:US
Practice Address - Phone:802-257-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003621183500000X
GARPH020130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist