Provider Demographics
NPI:1306981931
Name:KUPPER & SONS LLC
Entity type:Organization
Organization Name:KUPPER & SONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-364-0901
Mailing Address - Street 1:4934 MANSLICK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4026
Mailing Address - Country:US
Mailing Address - Phone:502-364-0901
Mailing Address - Fax:502-364-0407
Practice Address - Street 1:4934 MANSLICK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4026
Practice Address - Country:US
Practice Address - Phone:502-364-0901
Practice Address - Fax:502-364-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP067903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5400396700Medicaid
2034007OtherPK
KY5400396700Medicaid