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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054008430
IL
3336L0003X
Long Term Care Pharmacy
—
—
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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