Provider Demographics
NPI:1932513454
Name:CUPER, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:CUPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9305
Mailing Address - Country:US
Mailing Address - Phone:231-348-2767
Mailing Address - Fax:
Practice Address - Street 1:1133 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9305
Practice Address - Country:US
Practice Address - Phone:231-348-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist