Healthcare Provider Details

I. General information

NPI: 1295913291
Provider Name (Legal Business Name): SCOTT S. KUPERMAN PD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 WOODSIDE CT VITASCRIPT PHARMACY SUITE 102
COLUMBIA MD
21046-3227
US

IV. Provider business mailing address

6345 WOODSIDE CT VITASCRIPT PHARMACY SUITE 102
COLUMBIA MD
21046-3227
US

V. Phone/Fax

Practice location:
  • Phone: 410-309-7926
  • Fax: 410-309-5956
Mailing address:
  • Phone: 410-309-7926
  • Fax: 410-309-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: