Provider Demographics
NPI:1326395237
Name:COOPER, JENNIFER AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMANDA
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PEPPERS MILL DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8879
Mailing Address - Country:US
Mailing Address - Phone:270-554-8909
Mailing Address - Fax:
Practice Address - Street 1:3360 IRVIN COBB DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0501
Practice Address - Country:US
Practice Address - Phone:270-444-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist