Provider Demographics
NPI:1457647802
Name:COPPER, CLIFTON CARROLL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:CARROLL
Last Name:COPPER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:811 TOWN CENTER DR
Mailing Address - Street 2:T-2294
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9262
Mailing Address - Country:US
Mailing Address - Phone:540-941-2281
Mailing Address - Fax:540-941-2281
Practice Address - Street 1:811 TOWN CENTER DR
Practice Address - Street 2:T-2294
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9262
Practice Address - Country:US
Practice Address - Phone:540-941-2281
Practice Address - Fax:540-941-2281
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist