Provider Demographics
NPI:1609478288
Name:COOPER, CYNTHIA DIANNE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 SE 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6155
Mailing Address - Country:US
Mailing Address - Phone:405-618-9259
Mailing Address - Fax:
Practice Address - Street 1:3571 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2473
Practice Address - Country:US
Practice Address - Phone:405-515-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist