Provider Demographics
NPI:1750985941
Name:COPP-PETERSEN, BREANNA JEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:JEAN
Last Name:COPP-PETERSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04270-3329
Mailing Address - Country:US
Mailing Address - Phone:207-743-7982
Mailing Address - Fax:
Practice Address - Street 1:1603 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3329
Practice Address - Country:US
Practice Address - Phone:207-743-7982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR69930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist