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General NPI Number Information
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NPI Number | 1508467622
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Entity Type | Individual
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Provider Name | MISTIE MICHELLE COPELAND
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 951 W BELT LINE RD
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City | DESOTO
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State | TX
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Zip | 75115-3741
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Country | US
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Telephone | 972-223-1930
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Fax | 972-223-1926
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Provider Business Mailing Address
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Address Line | 5460 EVENING LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-7715
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Country | US
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Telephone | 936-443-7489
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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 | 37989
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License Number State | TX
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