Provider Demographics
NPI:1790384212
Name:COPILOT PROVIDER SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:COPILOT PROVIDER SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-272-1128
Mailing Address - Street 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE C130
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:855-272-1128
Mailing Address - Fax:855-272-1129
Practice Address - Street 1:8700 EAST PINNACLE PEAK ROAD STE 120
Practice Address - Street 2:JOHNSON BANK BUILDING
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8525
Practice Address - Country:US
Practice Address - Phone:877-272-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy