Provider Demographics
NPI:1134340441
Name:COOPER, VERNON FITZGERALD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:FITZGERALD
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 OLD CAPITOL TRL STE 1207
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6124
Mailing Address - Country:US
Mailing Address - Phone:800-206-1519
Mailing Address - Fax:
Practice Address - Street 1:3422 OLD CAPITOL TRL STE 1207
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6124
Practice Address - Country:US
Practice Address - Phone:800-206-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist