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Organization
COPPER BEND PHARMACY, INC
Active
Organization
COPPER BEND PHARMACY, INC
Active
Other names
COPPER BEND PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CLEMENT R.PH (PRESIDENT)
(618) 234-7181
Entity
Organization
Contact information
Practice address
2900 FRANK SCOTT PKWY W, STE 920-B, BELLEVILLE, IL 62223-5000
(618) 234-7181
(618) 234-9811
Mailing address
2900 FRANK SCOTT PKWY W, STE 920-B, BELLEVILLE, IL 62223-8509
(618) 234-7181
(618) 234-9811
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054008430
IL
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018496
PK
—
Enumeration date
08/31/2006
Last updated
12/08/2016
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