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General NPI Number Information
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NPI Number | 1013918655
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Entity Type | Organization
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Legal Business Name | KOPP PHARMACY
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 501 HOWARD AVE BLDG G
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City | ALTOONA
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State | PA
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Zip | 16601-4810
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Country | US
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Telephone | 814-943-0621
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Fax | 814-943-0632
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Provider Business Mailing Address
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Address Line | PO BOX 1471
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City | ALTOONA
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State | PA
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Zip | 16603-1471
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Country | US
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Telephone | 814-949-9512
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Fax | 914-949-9505
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Authorized Official
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Title or Position | COO
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Name | WILLIAM E EARNEST
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Credential | RPH
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Telephone | 814-949-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PP410198L
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License Number State | PA
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