Provider Demographics
NPI:1164529459
Name:COPPEROPOLIS PHARMACY
Entity Type:Organization
Organization Name:COPPEROPOLIS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-394-1732
Mailing Address - Street 1:49 COSMIC CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228-9300
Mailing Address - Country:US
Mailing Address - Phone:209-785-8787
Mailing Address - Fax:
Practice Address - Street 1:49 COSMIC CT
Practice Address - Street 2:SUITE C
Practice Address - City:COPPEROPOLIS
Practice Address - State:CA
Practice Address - Zip Code:95228-9300
Practice Address - Country:US
Practice Address - Phone:209-785-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy