Provider Demographics
NPI:1609175603
Name:COOLEY, JONNI KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JONNI
Middle Name:KAY
Last Name:COOLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 BLUEJAY LN
Mailing Address - Street 2:
Mailing Address - City:KEEZLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22832-2003
Mailing Address - Country:US
Mailing Address - Phone:540-269-2848
Mailing Address - Fax:
Practice Address - Street 1:1420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2911
Practice Address - Country:US
Practice Address - Phone:540-434-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12418183500000X
WVRP0005899183500000X
OH03221356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12418OtherVIRGINIA PHARMACY LICENSE NUMBER