Healthcare Provider Details

I. General information

NPI: 1669700845
Provider Name (Legal Business Name): COOPER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 STATE ST
AUGUSTA KS
67010
US

IV. Provider business mailing address

511 STATE ST
AUGUSTA KS
67010-1107
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-2289
  • Fax: 316-775-2280
Mailing address:
  • Phone: 316-775-2289
  • Fax: 316-775-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2-10266
License Number StateKS

VIII. Authorized Official

Name: BRETT KAPPELMANN
Title or Position: OWNER
Credential:
Phone: 316-775-2289