Provider Demographics
NPI:1710216478
Name:COOPER, RUTH S (RPH)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:S
Last Name:COOPER
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 1:4271 CADIZ DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5411
Mailing Address - Country:US
Mailing Address - Phone:817-897-6033
Mailing Address - Fax:
Practice Address - Street 1:1325 PENNSYLVANIA AVE # 60
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-882-8670
Practice Address - Fax:817-882-8792
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist