Provider Demographics
NPI:1497446512
Name:KOPP, KELLY LEE (CPHT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:KOPP
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5015
Mailing Address - Country:US
Mailing Address - Phone:603-223-6713
Mailing Address - Fax:603-225-8017
Practice Address - Street 1:165 N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5015
Practice Address - Country:US
Practice Address - Phone:603-223-6713
Practice Address - Fax:603-225-8017
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCPTH-127769183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician