Provider Demographics
NPI:1578641544
Name:COOPER, CARI D (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 GOLDEN POND DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-8122
Mailing Address - Country:US
Mailing Address - Phone:479-857-1478
Mailing Address - Fax:
Practice Address - Street 1:76 GOLDEN POND DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-8122
Practice Address - Country:US
Practice Address - Phone:479-857-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR9307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist