Provider Demographics
NPI:1386374841
Name:COPLAN, MISTY SHALON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:SHALON
Last Name:COPLAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:SHALON
Other - Last Name:LEFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:506 MILLER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2314
Mailing Address - Country:US
Mailing Address - Phone:928-442-0312
Mailing Address - Fax:928-442-0321
Practice Address - Street 1:506 MILLER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2314
Practice Address - Country:US
Practice Address - Phone:928-442-0312
Practice Address - Fax:928-442-0321
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist