Provider Demographics
NPI:1164696795
Name:KOPPEL, HAROLD BERND (RPH)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:BERND
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-8917
Mailing Address - Country:US
Mailing Address - Phone:845-354-9320
Mailing Address - Fax:845-354-9322
Practice Address - Street 1:728 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-8917
Practice Address - Country:US
Practice Address - Phone:845-354-9320
Practice Address - Fax:845-354-9322
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02695009Medicaid