Provider Demographics
NPI:1417232877
Name:KOPF, BRIAN ANDREW (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANDREW
Last Name:KOPF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3034
Mailing Address - Country:US
Mailing Address - Phone:563-359-3438
Mailing Address - Fax:563-359-3762
Practice Address - Street 1:4011 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3034
Practice Address - Country:US
Practice Address - Phone:563-359-3438
Practice Address - Fax:563-359-3762
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15731183500000X
CO13384183500000X
IL051.036531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist