Healthcare Provider Details

I. General information

NPI: 1306981931
Provider Name (Legal Business Name): KUPPER & SONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4934 MANSLICK RD
LOUISVILLE KY
40216-4026
US

IV. Provider business mailing address

4934 MANSLICK RD
LOUISVILLE KY
40216-4026
US

V. Phone/Fax

Practice location:
  • Phone: 502-364-0901
  • Fax: 502-364-0407
Mailing address:
  • Phone: 502-364-0901
  • Fax: 502-364-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06790
License Number StateKY

VIII. Authorized Official

Name: MARK KUPPER
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 502-364-0901