Provider Demographics
NPI:1821775784
Name:COOPER, TANNER JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:JAMES
Last Name:COOPER
Suffix:
Gender:M
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-0003
Mailing Address - Country:US
Mailing Address - Phone:479-597-9795
Mailing Address - Fax:
Practice Address - Street 1:810 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-3010
Practice Address - Country:US
Practice Address - Phone:479-667-4145
Practice Address - Fax:479-667-4879
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist