Active NPI
Samantha Coppola
- Pharmacist
- Vicksburg, MS
National Provider Identifier
1134894660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-100344
- Practice address
- 3341 Halls Ferry Rd
Vicksburg, MS 39180-5338 - Phone
- (601) 661-9340
- NPI assigned
- Aug 16, 2021
- Last updated
- Aug 16, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-100344 | MS | Primary |
Addresses
Primary practice location
3341 Halls Ferry Rd
Vicksburg, MS 39180-5338
Mailing address
1707 East Ave
Vicksburg, MS 39180-3722
Phone (971) 295-9458
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-100344 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629072000000",
"number": "1134894660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 EAST AVE",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803722",
"telephone_number": "971-295-9458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3341 HALLS FERRY RD",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391805338",
"telephone_number": "601-661-9340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-16",
"last_updated": "2021-08-16",
"certification_date": "2021-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-100344",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.