Provider Demographics
NPI:1538446091
Name:KOPF, PRESTON J JR (DPH)
Entity type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:J
Last Name:KOPF
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5027
Mailing Address - Country:US
Mailing Address - Phone:615-595-1853
Mailing Address - Fax:615-595-6180
Practice Address - Street 1:1509 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5027
Practice Address - Country:US
Practice Address - Phone:615-595-1853
Practice Address - Fax:615-595-6180
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN035461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPJK5JANEMedicaid
TNPJK5JANEMedicare PIN
TNPJKK5JANEMedicare UPIN
TNPJK5JANEMedicaid