Provider Demographics
NPI:1619286697
Name:COPPOLA, ALAN J (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:COPPOLA
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 1:18420 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1361
Mailing Address - Country:US
Mailing Address - Phone:602-993-6610
Mailing Address - Fax:602-866-9918
Practice Address - Street 1:18420 N. 19TH AVE.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1361
Practice Address - Country:US
Practice Address - Phone:602-993-6610
Practice Address - Fax:602-866-9918
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS006873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist