Healthcare Provider Details

I. General information

NPI: 1720994528
Provider Name (Legal Business Name): JAYDEN COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N ANKENY BLVD
ANKENY IA
50023-1753
US

IV. Provider business mailing address

632 NE 56TH ST
ANKENY IA
50021-6585
US

V. Phone/Fax

Practice location:
  • Phone: 515-971-9169
  • Fax:
Mailing address:
  • Phone: 515-971-9169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25628
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: