MEDICARE: DR. WAYNE M COPP PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	2754	TN

General Provider Information

NPI Number	:	1467679001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE M COPP PHARM.D.

Provider Business Mailing Address
First Line	:	222 E WATAUGA AVE
Second Line	:	BLANKENSHIP PHARMACY
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4630
Country	:	US
Telephone Number	:	423-926-4801
Fax Number	:	423-929-1381

Provider Business Practice Location Address
First Line	:	222 E WATAUGA AVE
Second Line	:	BLANKENSHIP PHARMACY
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4630
Country	:	US
Telephone Number	:	423-926-4801
Fax Number	:	423-929-1381

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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