Provider Demographics
NPI:1699170779
Name:KOPPINGER, JANINE
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:KOPPINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4591 W 27TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7546
Mailing Address - Country:US
Mailing Address - Phone:928-580-1133
Mailing Address - Fax:
Practice Address - Street 1:2900 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3500
Practice Address - Country:US
Practice Address - Phone:928-341-1288
Practice Address - Fax:928-341-0546
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9699183500000X
ND3768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist