Provider Demographics
NPI:1932494879
Name:COOPER, CRAIG ARTHUR (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ARTHUR
Last Name:COOPER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20877 HALL ROAD
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044
Mailing Address - Country:US
Mailing Address - Phone:586-464-1129
Mailing Address - Fax:586-464-1139
Practice Address - Street 1:20877 HALL ROAD
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-464-1129
Practice Address - Fax:586-464-1139
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020234681835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist