1821099847 NPI number — KOPP DRUG INC.

Table of content: (NPI 1821099847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099847 NPI number — KOPP DRUG INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOPP DRUG INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821099847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1471
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16603-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-949-9512
Provider Business Mailing Address Fax Number:
814-949-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3106 E PLEASANT VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-8935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-742-8429
Provider Business Practice Location Address Fax Number:
814-742-8540
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EARNEST
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
814-949-9512

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PP-413371-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007336010014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007336010030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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