Healthcare Provider Details

I. General information

NPI: 1962402404
Provider Name (Legal Business Name): KOPP DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BLAIR ST
HOLLIDAYSBURG PA
16648-2445
US

IV. Provider business mailing address

PO BOX 1471
ALTOONA PA
16603-1471
US

V. Phone/Fax

Practice location:
  • Phone: 814-696-0289
  • Fax: 814-695-8241
Mailing address:
  • Phone: 814-949-9512
  • Fax: 814-949-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP411048-L
License Number StatePA

VIII. Authorized Official

Name: WILLIAM E EARNEST
Title or Position: COO
Credential: RPH
Phone: 814-949-9512