Healthcare Provider Details

I. General information

NPI: 1972800746
Provider Name (Legal Business Name): KRISTOPHER KOPEC PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 LANDSTUHL REGIONAL MEDICAL CENTER
APO AE
09180
US

IV. Provider business mailing address

CMR 402 LANDSTUHL REGIONAL MEDICAL CENTER
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 496374867570
  • Fax: 496371865121
Mailing address:
  • Phone: 496371867570
  • Fax: 496371865121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17854
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: