=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174223325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE BETH KOPP PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N. RIVER ST. SUITE 2&3
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-745-3320
-----------------------------------------------------
Fax | 605-745-3324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12538 BEAVER CREEK ROAD P.O. BOX 211
-----------------------------------------------------
City | PRINGLE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-673-2750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | R-5924
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------