Provider Demographics
NPI:1326303397
Name:COPP, TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COPP
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 1:17514 COUNTY ROAD 209
Mailing Address - Street 2:
Mailing Address - City:MOUNT VICTORY
Mailing Address - State:OH
Mailing Address - Zip Code:43340-8849
Mailing Address - Country:US
Mailing Address - Phone:937-354-2323
Mailing Address - Fax:
Practice Address - Street 1:332 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5006
Practice Address - Country:US
Practice Address - Phone:740-382-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031319341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist