MEDICARE: DR. ROY DALE COPE 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	183500000X	Pharmacist	RPH023763	GA
2	183500000X	Pharmacist	28798	TN

General Provider Information

NPI Number	:	1972814945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY DALE COPE PHARM.D.

Provider Business Mailing Address
First Line	:	67 POPLAR SPRINGS RD
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2808
Country	:	US
Telephone Number	:	706-935-6900
Fax Number	:	706-935-6929

Provider Business Practice Location Address
First Line	:	67 POPLAR SPRINGS RD
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2808
Country	:	US
Telephone Number	:	706-935-6900
Fax Number	:	706-935-6929

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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