Provider Demographics
NPI:1467679001
Name:COPP, WAYNE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:M
Last Name:COPP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E WATAUGA AVE
Mailing Address - Street 2:BLANKENSHIP PHARMACY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4630
Mailing Address - Country:US
Mailing Address - Phone:423-926-4801
Mailing Address - Fax:423-929-1381
Practice Address - Street 1:222 E WATAUGA AVE
Practice Address - Street 2:BLANKENSHIP PHARMACY
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4630
Practice Address - Country:US
Practice Address - Phone:423-926-4801
Practice Address - Fax:423-929-1381
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27541835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy