Provider Demographics
NPI:1821761669
Name:COOPER, PHILLIP (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
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 1:3297 W UPPER HUNTLY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-2525
Mailing Address - Country:US
Mailing Address - Phone:435-669-2233
Mailing Address - Fax:
Practice Address - Street 1:11100 S AUTO MALL DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4171
Practice Address - Country:US
Practice Address - Phone:801-790-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10970661-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist