Healthcare Provider Details

I. General information

NPI: 1356542807
Provider Name (Legal Business Name): DAVID KUPPERMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CHERRY ST STE 1700
PHILADELPHIA PA
19102-1321
US

IV. Provider business mailing address

2408 OLCOTT AVE
ARDMORE PA
19003-2612
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-1700
  • Fax:
Mailing address:
  • Phone: 215-432-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP043623L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: