Provider Demographics
NPI:1205113768
Name:COOPER, BARRY L (DPH)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 E 132ND PL S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-5224
Mailing Address - Country:US
Mailing Address - Phone:918-369-6781
Mailing Address - Fax:
Practice Address - Street 1:11417 E 132ND PL S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-5224
Practice Address - Country:US
Practice Address - Phone:918-369-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist