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General NPI Number Information
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NPI Number | 1316805690
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Entity Type | Organization
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Legal Business Name | COPPER STATE LABORATORY SERVICES
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 2450 W BROADWAY RD STE 120
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City | MESA
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State | AZ
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Zip | 85202-1072
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Country | US
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Telephone | 480-621-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 W BROADWAY RD STE 120
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City | MESA
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State | AZ
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Zip | 85202-1072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. DAVID RICHARDSON
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Credential | PSM
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Telephone | 480-621-8517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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