Provider Demographics
NPI:1245723857
Name:COOLEY, MICHAEL HARVEY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HARVEY
Last Name:COOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27280 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-8601
Mailing Address - Country:US
Mailing Address - Phone:515-707-4803
Mailing Address - Fax:
Practice Address - Street 1:404 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1730
Practice Address - Country:US
Practice Address - Phone:515-996-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist