Healthcare Provider Details

I. General information

NPI: 1801896725
Provider Name (Legal Business Name): BRIAN J KOPP PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

10578 E BONPLAND WILLOW DR
TUCSON AZ
85747-9541
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-2173
  • Fax:
Mailing address:
  • Phone: 520-574-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: