Healthcare Provider Details

I. General information

NPI: 1558828939
Provider Name (Legal Business Name): NATALIE KOPTYEV PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108-14 68TH DRIVE
FOREST HILLS NY
11375
US

IV. Provider business mailing address

10814 68TH DR
FOREST HILLS NY
11375-2951
US

V. Phone/Fax

Practice location:
  • Phone: 347-853-2809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: