Provider Demographics
NPI:1699364836
Name:COOPER, CLAY MATHEW (CPHT)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:MATHEW
Last Name:COOPER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W SLAUGHTER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5992
Mailing Address - Country:US
Mailing Address - Phone:512-282-0990
Mailing Address - Fax:
Practice Address - Street 1:2110 W SLAUGHTER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5992
Practice Address - Country:US
Practice Address - Phone:512-282-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30077908183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician