Healthcare Provider Details

I. General information

NPI: 1851845390
Provider Name (Legal Business Name): DANIELLE EILEEN COPUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2016
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5498 MAHONING AVE
YOUNGSTOWN OH
44515-2418
US

IV. Provider business mailing address

5876 COUNTRY TRL
YOUNGSTOWN OH
44515-5575
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-4409
  • Fax:
Mailing address:
  • Phone: 330-974-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022053
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03236663
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: