Healthcare Provider Details

I. General information

NPI: 1508467614
Provider Name (Legal Business Name): CARRIE KOPCHO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 US HIGHWAY 19
NEW PORT RICHEY FL
34652-5441
US

IV. Provider business mailing address

4330 US HIGHWAY 19
NEW PORT RICHEY FL
34652-5441
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-1483
  • Fax:
Mailing address:
  • Phone: 727-815-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: