Provider Demographics
NPI:1043570138
Name:COOPER, BENJAMIN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:COOPER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2284 HEAVNER RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-8553
Mailing Address - Country:US
Mailing Address - Phone:704-748-1396
Mailing Address - Fax:
Practice Address - Street 1:1446 E GASTON ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4400
Practice Address - Country:US
Practice Address - Phone:704-732-1194
Practice Address - Fax:704-732-9709
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist