Provider Demographics
NPI:1144673427
Name:COOPER, KATHLEEN ANN (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3738
Mailing Address - Country:US
Mailing Address - Phone:252-758-4104
Mailing Address - Fax:252-758-8081
Practice Address - Street 1:704 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3738
Practice Address - Country:US
Practice Address - Phone:252-758-4104
Practice Address - Fax:252-758-8081
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist