Provider Demographics
NPI:1184853210
Name:COOPER, TABITHA RENEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:RENEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-0220
Mailing Address - Country:US
Mailing Address - Phone:903-949-1462
Mailing Address - Fax:
Practice Address - Street 1:27 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-0220
Practice Address - Country:US
Practice Address - Phone:903-949-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist