Provider Demographics
NPI:1295913291
Name:KUPERMAN, SCOTT S (PD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:S
Last Name:KUPERMAN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 WOODSIDE CT
Mailing Address - Street 2:VITASCRIPT PHARMACY SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3227
Mailing Address - Country:US
Mailing Address - Phone:410-309-7926
Mailing Address - Fax:410-309-5956
Practice Address - Street 1:6345 WOODSIDE CT
Practice Address - Street 2:VITASCRIPT PHARMACY SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3227
Practice Address - Country:US
Practice Address - Phone:410-309-7926
Practice Address - Fax:410-309-5956
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist