# COPPER BEND PHARMACY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COPPER BEND PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902918840
- **Authorized official:** STEPHEN CLEMENT R.PH (PRESIDENT)
- **Authorized official phone:** (618) 234-7181

## Contact information

- **Practice address:** 2900 FRANK SCOTT PKWY W, STE 920-B, BELLEVILLE, IL 62223-5000
- **Practice address phone:** (618) 234-7181
- **Practice address fax:** (618) 234-9811
- **Mailing address:** 2900 FRANK SCOTT PKWY W, STE 920-B, BELLEVILLE, IL 62223-8509
- **Mailing address phone:** (618) 234-7181
- **Mailing address fax:** (618) 234-9811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054008430 | IL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 12/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2018496 | PK | — |