Healthcare Provider Details

I. General information

NPI: 1053617803
Provider Name (Legal Business Name): MICHAEL EUGENE COPPI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAPLE ST
CORNISH ME
04020-3141
US

IV. Provider business mailing address

200 MAPLE ST
CORNISH ME
04020-3141
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-8050
  • Fax: 207-625-4628
Mailing address:
  • Phone: 207-625-8050
  • Fax: 207-625-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR3927
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: