Provider Demographics
NPI:1760935654
Name:NECAISE COOPER, STEPHANIE ANN (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:NECAISE COOPER
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 HIGHWAY 49 STE H
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3087
Mailing Address - Country:US
Mailing Address - Phone:228-832-0051
Mailing Address - Fax:228-832-0168
Practice Address - Street 1:11312 HIGHWAY 49 STE H
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3087
Practice Address - Country:US
Practice Address - Phone:228-832-0051
Practice Address - Fax:228-832-0168
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE14515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist