Provider Demographics
NPI:1407163975
Name:COOPER, ADAM K (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:K
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 BALMER ST
Mailing Address - Street 2:BLDG 570
Mailing Address - City:HILL AIR FORCE BZASE
Mailing Address - State:UT
Mailing Address - Zip Code:84056
Mailing Address - Country:US
Mailing Address - Phone:801-777-0419
Mailing Address - Fax:801-777-1800
Practice Address - Street 1:7321 BALMER ST
Practice Address - Street 2:BLDG 570
Practice Address - City:HILL AIR FORCE BZASE
Practice Address - State:UT
Practice Address - Zip Code:84056
Practice Address - Country:US
Practice Address - Phone:801-777-0419
Practice Address - Fax:801-777-1800
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8078526-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist