Provider Demographics
NPI:1295276525
Name:COOPER, CASEY PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:PAUL
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 1:603 QUAIL CREEK DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1654
Mailing Address - Country:US
Mailing Address - Phone:806-352-1212
Mailing Address - Fax:806-352-1211
Practice Address - Street 1:603 QUAIL CREEK DR
Practice Address - Street 2:SUITE 700
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1654
Practice Address - Country:US
Practice Address - Phone:806-352-1212
Practice Address - Fax:806-352-1211
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44376183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support