Healthcare Provider Details

I. General information

NPI: 1467829119
Provider Name (Legal Business Name): PATRICK KUPCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ROUTE 206
HILLSBOROUGH NJ
08844-1549
US

IV. Provider business mailing address

28516 DUPONT BLVD
MILLSBORO DE
19966-4739
US

V. Phone/Fax

Practice location:
  • Phone: 908-281-6539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004773
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: