Provider Demographics
NPI:1518502293
Name:COOPER, HAYLEY (PS)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CRETE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2431
Mailing Address - Country:US
Mailing Address - Phone:904-673-4985
Mailing Address - Fax:
Practice Address - Street 1:300 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8540
Practice Address - Country:US
Practice Address - Phone:352-336-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist