Provider Demographics
NPI:1750601415
Name:COPPERMAN, MARY ANN
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:COPPERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 KNIGHTS BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2051
Mailing Address - Country:US
Mailing Address - Phone:609-829-2405
Mailing Address - Fax:
Practice Address - Street 1:1006 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1821
Practice Address - Country:US
Practice Address - Phone:609-965-0520
Practice Address - Fax:609-965-1953
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI22837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist