MEDICARE: KOPP DRUG INC

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	333600000X	Pharmacy	PP411048-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962402404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOPP DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 1471
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16603-1471
Country	:	US
Telephone Number	:	814-949-9512
Fax Number	:	814-949-9505

Provider Business Practice Location Address
First Line	:	1201 BLAIR ST
Second Line	:
City	:	HOLLIDAYSBURG
State	:	PA
Zip	:	16648-2445
Country	:	US
Telephone Number	:	814-696-0289
Fax Number	:	814-695-8241

Authorized Official
Title or Position	:	COO
Name	:	WILLIAM E EARNEST
Credential	:	RPH
Telephone Number	:	814-949-9512

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	08/27/2008

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Directions to “KOPP DRUG INC ” Practice Location

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