Provider Demographics
NPI:1124641949
Name:COOPERMAN, TODD (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAMPDEN CIR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1265
Mailing Address - Country:US
Mailing Address - Phone:860-965-8719
Mailing Address - Fax:
Practice Address - Street 1:1100 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1363
Practice Address - Country:US
Practice Address - Phone:203-747-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist