Provider Demographics
NPI:1194002626
Name:KOPINSKI, JASON JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:KOPINSKI
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 1:6016 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4318
Mailing Address - Country:US
Mailing Address - Phone:773-788-0180
Mailing Address - Fax:773-788-0266
Practice Address - Street 1:6016 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4318
Practice Address - Country:US
Practice Address - Phone:773-788-0180
Practice Address - Fax:773-788-0266
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist