Provider Demographics
NPI:1619009313
Name:COOGLER, BEVERLY O (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:O
Last Name:COOGLER
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 1:199 BURG RD
Mailing Address - Street 2:
Mailing Address - City:JENKINSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30234-2004
Mailing Address - Country:US
Mailing Address - Phone:770-775-2112
Mailing Address - Fax:770-775-2112
Practice Address - Street 1:3798 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3632
Practice Address - Country:US
Practice Address - Phone:770-957-6004
Practice Address - Fax:770-914-0961
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist