Provider Demographics
NPI:1568667194
Name:COOPER, WILLIAM CLIFFORD
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLIFFORD
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12259 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-1634
Mailing Address - Country:US
Mailing Address - Phone:410-352-5889
Mailing Address - Fax:
Practice Address - Street 1:714 N PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-3847
Practice Address - Country:US
Practice Address - Phone:410-289-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist