Provider Demographics
NPI:1942804125
Name:KOPP, SIERRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:KOPP
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 1:150 MORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6200
Mailing Address - Country:US
Mailing Address - Phone:219-462-2994
Mailing Address - Fax:
Practice Address - Street 1:150 MORTHLAND DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6200
Practice Address - Country:US
Practice Address - Phone:219-462-2994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024670A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist