Provider Demographics
NPI:1619301538
Name:COOLEY, DERYL FREEMAN II (PHARMD)
Entity Type:Individual
Prefix:
First Name:DERYL
Middle Name:FREEMAN
Last Name:COOLEY
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7902
Mailing Address - Country:US
Mailing Address - Phone:480-218-8573
Mailing Address - Fax:
Practice Address - Street 1:4440 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7902
Practice Address - Country:US
Practice Address - Phone:480-218-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist