Healthcare Provider Details

I. General information

NPI: 1841570454
Provider Name (Legal Business Name): JEFFREY M KUPIEC RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N STATE ROAD 7
COCONUT CREEK FL
33073-4303
US

IV. Provider business mailing address

4601 N STATE ROAD 7
COCONUT CREEK FL
33073-4303
US

V. Phone/Fax

Practice location:
  • Phone: 954-345-4456
  • Fax: 954-345-5138
Mailing address:
  • Phone: 954-345-4456
  • Fax: 954-345-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: