Provider Demographics
NPI:1194726646
Name:KOPP DRUG INC
Entity type:Organization
Organization Name:KOPP DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-949-9512
Mailing Address - Street 1:PO BOX 1471
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16603
Mailing Address - Country:US
Mailing Address - Phone:814-949-9512
Mailing Address - Fax:814-949-9505
Practice Address - Street 1:700 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6341
Practice Address - Country:US
Practice Address - Phone:814-946-0479
Practice Address - Fax:814-941-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411275L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007336010029Medicaid
PA0480500004Medicare NSC