Healthcare Provider Details

I. General information

NPI: 1538446091
Provider Name (Legal Business Name): PRESTON J KOPF JR. DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 MURFREESBORO RD
FRANKLIN TN
37067-5027
US

IV. Provider business mailing address

1509 MURFREESBORO RD
FRANKLIN TN
37067-5027
US

V. Phone/Fax

Practice location:
  • Phone: 615-595-1853
  • Fax: 615-595-6180
Mailing address:
  • Phone: 615-595-1853
  • Fax: 615-595-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03546
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: