Provider Demographics
NPI:1922718634
Name:COOPER, WESLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
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 1:10142 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1372
Mailing Address - Country:US
Mailing Address - Phone:210-998-2671
Mailing Address - Fax:210-998-2672
Practice Address - Street 1:10142 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1372
Practice Address - Country:US
Practice Address - Phone:210-998-2671
Practice Address - Fax:210-998-2672
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57264183500000X, 1835N0905X
4516092471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
No183500000XPharmacy Service ProvidersPharmacist
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology