Healthcare Provider Details

I. General information

NPI: 1710313671
Provider Name (Legal Business Name): SEAN COOPER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 159
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 159
COEUR D ALENE ID
83814-4401
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-5697
  • Fax: 208-769-8508
Mailing address:
  • Phone: 208-625-5697
  • Fax: 208-769-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5674
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: