Provider Demographics
NPI:1295552545
Name:COPE, MACULLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MACULLEN
Middle Name:
Last Name:COPE
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 1:2601 W 7TH ST APT 1210
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2286
Mailing Address - Country:US
Mailing Address - Phone:518-569-2796
Mailing Address - Fax:
Practice Address - Street 1:1200 MEANDERING RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-2416
Practice Address - Country:US
Practice Address - Phone:817-782-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist