Provider Demographics
NPI:1497754626
Name:COOVER, KELLI LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:COOVER
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 1:6715 N 106TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1046
Mailing Address - Country:US
Mailing Address - Phone:402-493-4467
Mailing Address - Fax:
Practice Address - Street 1:7915 N 30TH ST
Practice Address - Street 2:7915 N 30 ST
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2418
Practice Address - Country:US
Practice Address - Phone:402-827-6080
Practice Address - Fax:402-827-6085
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106021835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy