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General NPI Number Information
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NPI Number | 1154543890
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Entity Type | Individual
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Provider Name | CHARLES STEVEN KOOPMAN PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-1500
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Country | US
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Telephone | 909-825-7084
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Fax | 909-422-3017
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Provider Business Mailing Address
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Address Line | 6624 VENETO PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-9018
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Country | US
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Telephone | 909-219-1412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 68391
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5928902-1701
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License Number State | UT
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