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General NPI Number Information
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NPI Number | 1164529459
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Entity Type | Organization
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Legal Business Name | COPPEROPOLIS PHARMACY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 49 COSMIC CT SUITE C
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City | COPPEROPOLIS
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State | CA
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Zip | 95228-9300
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Country | US
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Telephone | 209-785-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 49 COSMIC CT SUITE C
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City | COPPEROPOLIS
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State | CA
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Zip | 95228-9300
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Country | US
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Telephone | 209-785-8787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN TOM
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Credential | PHARMD
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Telephone | 916-394-1732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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