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NPI Code Detail

MEDICARE: DONALD ALLEN COOPER

MEDICARE: DONALD ALLEN COOPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistRPH024174GA

General Provider Information

NPI Number : 1962033308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD ALLEN COOPER
Provider Business Mailing Address
First Line : 4321 HARTLEY BRIDGE RD
Second Line :
City : MACON
State : GA
Zip : 31216-5641
Country : US
Telephone Number : 478-788-1015
Fax Number : 478-788-2050
Provider Business Practice Location Address
First Line : 4321 HARTLEY BRIDGE RD
Second Line :
City : MACON
State : GA
Zip : 31216-5641
Country : US
Telephone Number : 478-788-1015
Fax Number : 478-788-2050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2020
Last Update Date : 02/03/2020

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Directions to “ DONALD ALLEN COOPER ” Practice Location

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