Provider Demographics
NPI:1710205109
Name:COOPER, TERRY KEITH JR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:KEITH
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:CPHT
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Mailing Address - Street 1:26357 MEREDITH STREET
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559
Mailing Address - Country:US
Mailing Address - Phone:956-202-1594
Mailing Address - Fax:956-525-7721
Practice Address - Street 1:800 E ALTON GLOOR BLVD UPPR B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4296
Practice Address - Country:US
Practice Address - Phone:956-525-7759
Practice Address - Fax:956-525-7721
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2018-04-17
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Provider Licenses
StateLicense IDTaxonomies
TX117327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician