Individual
THAD A KOPPENHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
US HWY 491 N, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15373
CO
Other
Enumeration date
11/02/2005
Last updated
02/08/2008
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