Healthcare Provider Details

I. General information

NPI: 1922519636
Provider Name (Legal Business Name): JOEL LA'MONT COPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 COMMERCIAL CENTRE DR
BRIDGEVILLE DE
19933-3822
US

IV. Provider business mailing address

9202 COMMERCIAL CENTER DR
BRIDGEVILLE DE
19933
US

V. Phone/Fax

Practice location:
  • Phone: 302-337-9785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0005146
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: