Provider Demographics
NPI:1821676065
Name:COOLEY, COLLEEN THERESA I (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:THERESA
Last Name:COOLEY
Suffix:I
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 PETROL ST APT 10
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5704
Mailing Address - Country:US
Mailing Address - Phone:714-488-4911
Mailing Address - Fax:
Practice Address - Street 1:13401 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9123
Practice Address - Country:US
Practice Address - Phone:760-244-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist