Provider Demographics
NPI:1457584377
Name:COOPER, DIXIE A (RPH)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2263
Mailing Address - Country:US
Mailing Address - Phone:864-597-1559
Mailing Address - Fax:
Practice Address - Street 1:140 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2263
Practice Address - Country:US
Practice Address - Phone:864-597-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9136OtherPHARMACIST LICENSE NUMBER