Healthcare Provider Details

I. General information

NPI: 1366001083
Provider Name (Legal Business Name): KOP COMMUNITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 SHOEMAKER RD STE 140
KING OF PRUSSIA PA
19406-4203
US

IV. Provider business mailing address

PO BOX 855
TREXLERTOWN PA
18087-0855
US

V. Phone/Fax

Practice location:
  • Phone: 802-725-0081
  • Fax:
Mailing address:
  • Phone: 802-725-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: H PATEL
Title or Position: MEMBER
Credential:
Phone: 802-725-0081