Provider Demographics
NPI:1518235373
Name:COOPER, VALERIE LYNN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:VALERIE
Middle Name:LYNN
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:PO BOX PH
Mailing Address - Street 2:HIGHWAY 191
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7526
Mailing Address - Fax:928-674-7463
Practice Address - Street 1:10566 HIGHWAY 191
Practice Address - Street 2:PO DRAWER PH
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7526
Practice Address - Fax:928-674-7463
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033308371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273855Medicaid
OR273855Medicaid