Provider Demographics
NPI:1154543890
Name:KOOPMAN, CHARLES STEVEN (PHARM D)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEVEN
Last Name:KOOPMAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 VENETO PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9018
Mailing Address - Country:US
Mailing Address - Phone:909-219-1412
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1500
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-422-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68391183500000X
UT5928902-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist