Provider Demographics
NPI:1497044655
Name:COOPER, NICKI LEIGH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:NICKI
Middle Name:LEIGH
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 1:520 LANARKSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2294
Mailing Address - Country:US
Mailing Address - Phone:270-234-3479
Mailing Address - Fax:
Practice Address - Street 1:520 LANARKSHIRE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2294
Practice Address - Country:US
Practice Address - Phone:270-234-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist