Basic Information
| Provider Information | |||||||||
| NPI: | 1295276525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 QUAIL CREEK DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791241654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063521212 | ||||||||
| FaxNumber: | 8063521211 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 QUAIL CREEK DR | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791241654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063521212 | ||||||||
| FaxNumber: | 8063521211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 44376 | TX | Y | Pharmacy Service Providers | Pharmacist | 1835N1003X | 44376 | TX | N | Pharmacy Service Providers | Pharmacist | Nutrition Support |
No ID Information.