Provider Demographics
NPI:1043619653
Name:KOOPMAN, GREGORY W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:KOOPMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11729 BELTSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3147
Mailing Address - Country:US
Mailing Address - Phone:301-572-5500
Mailing Address - Fax:
Practice Address - Street 1:11729 BELTSVILLE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3147
Practice Address - Country:US
Practice Address - Phone:301-572-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist