Healthcare Provider Details

I. General information

NPI: 1588932024
Provider Name (Legal Business Name): BRIAN KOPCZA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE
BOSTON MA
02118-4001
US

IV. Provider business mailing address

88 E NEWTON ST
BOSTON MA
02118-2308
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-5625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH234580
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0012001
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60288107
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH234580
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: