Provider Demographics
NPI:1649882614
Name:KOPALA, HERMINE JOELLE (RPH)
Entity type:Individual
Prefix:
First Name:HERMINE
Middle Name:JOELLE
Last Name:KOPALA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FERN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1917
Mailing Address - Country:US
Mailing Address - Phone:502-964-7114
Mailing Address - Fax:
Practice Address - Street 1:3600 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1917
Practice Address - Country:US
Practice Address - Phone:502-964-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist