Provider Demographics
NPI:1265832539
Name:COOPER, KAY (RPH)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
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 1:10095 WARD RD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2731
Mailing Address - Country:US
Mailing Address - Phone:410-257-0191
Mailing Address - Fax:410-257-2484
Practice Address - Street 1:10095 WARD RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2731
Practice Address - Country:US
Practice Address - Phone:410-257-0191
Practice Address - Fax:410-257-2484
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist