Provider Demographics
NPI:1295989176
Name:COOPER, STACY E (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3501
Mailing Address - Country:US
Mailing Address - Phone:870-238-8511
Mailing Address - Fax:870-238-2135
Practice Address - Street 1:411 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-238-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD10812OtherPHARMACY LICENSE NUMBER