Provider Demographics
NPI:1619486883
Name:KOPANSKI, ANASTAZJA
Entity type:Individual
Prefix:
First Name:ANASTAZJA
Middle Name:
Last Name:KOPANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 CATALPA AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4913
Mailing Address - Country:US
Mailing Address - Phone:347-515-8874
Mailing Address - Fax:
Practice Address - Street 1:5701 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4902
Practice Address - Country:US
Practice Address - Phone:718-366-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist