Provider Demographics
NPI:1477847747
Name:KOLUPA, LOUIS BERNARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:BERNARD
Last Name:KOLUPA
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 1:7815 BERGAMO AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4759
Mailing Address - Country:US
Mailing Address - Phone:941-922-8268
Mailing Address - Fax:
Practice Address - Street 1:8401 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2927
Practice Address - Country:US
Practice Address - Phone:941-922-8268
Practice Address - Fax:941-922-8268
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist