Provider Demographics
NPI:1679861892
Name:COOPER, CLAY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:M
Last Name:COOPER
Suffix:
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 1:1392 HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2342
Mailing Address - Country:US
Mailing Address - Phone:731-608-0513
Mailing Address - Fax:
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6114
Practice Address - Country:US
Practice Address - Phone:731-265-6555
Practice Address - Fax:731-265-6558
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist