Provider Demographics
NPI:1881998342
Name:KOPIN, BETHANY ANN (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:ANN
Last Name:KOPIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:ANN
Other - Last Name:MARKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14 SANFILIPPO CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1209
Mailing Address - Country:US
Mailing Address - Phone:585-261-9628
Mailing Address - Fax:
Practice Address - Street 1:14 SANFILIPPO CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1209
Practice Address - Country:US
Practice Address - Phone:585-261-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist