Provider Demographics
NPI:1851668099
Name:COOPER, JOHN (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 E NORRIS DR
Mailing Address - Street 2:WALGREENS STORE # 3009
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2316
Mailing Address - Country:US
Mailing Address - Phone:815-433-0485
Mailing Address - Fax:815-433-3843
Practice Address - Street 1:545 E NORRIS DR
Practice Address - Street 2:WALGREENS STORE # 3009
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2316
Practice Address - Country:US
Practice Address - Phone:815-433-0485
Practice Address - Fax:815-433-3843
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist