MEDICARE: MARCI KOPPENHAVER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15721	NC

General Provider Information

NPI Number	:	1235437203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCI KOPPENHAVER RPH

Provider Business Mailing Address
First Line	:	2508 CALGARY PL NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-3307
Country	:	US
Telephone Number	:	704-262-3947
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 POPLAR TENT RD
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-7757
Country	:	US
Telephone Number	:	700-478-2172
Fax Number	:	704-782-2123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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