Provider Demographics
NPI:1306960398
Name:KOPIAK, CAROL LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:KOPIAK
Suffix:
Gender:F
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 1:55 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4209
Mailing Address - Country:US
Mailing Address - Phone:570-823-9967
Mailing Address - Fax:570-829-2385
Practice Address - Street 1:20 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1213
Practice Address - Country:US
Practice Address - Phone:570-824-7242
Practice Address - Fax:570-829-2385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040464L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist