Provider Demographics
NPI:1487977922
Name:COPPOLA, ANTHONY MAURO (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MAURO
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4121 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6655
Mailing Address - Country:US
Mailing Address - Phone:248-850-1802
Mailing Address - Fax:248-850-1803
Practice Address - Street 1:DYNAMIC CARE PHARMACY
Practice Address - Street 2:4121 W. 13 MILE ROAD
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-850-1802
Practice Address - Fax:248-850-1803
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01724700183500000X
MI5302413160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist