Provider Demographics
NPI:1689918286
Name:COPPENBARGER, MELANIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:COPPENBARGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611
Mailing Address - Country:US
Mailing Address - Phone:309-427-2931
Mailing Address - Fax:309-427-2932
Practice Address - Street 1:301 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611
Practice Address - Country:US
Practice Address - Phone:309-427-2931
Practice Address - Fax:309-427-2932
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist