Provider Demographics
NPI:1497436927
Name:COOPER, CORYMARIE (RPH)
Entity Type:Individual
Prefix:
First Name:CORYMARIE
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 1:47 FURMAN LN
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-9504
Mailing Address - Country:US
Mailing Address - Phone:406-240-4870
Mailing Address - Fax:
Practice Address - Street 1:2611 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3759
Practice Address - Country:US
Practice Address - Phone:406-782-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-98105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist