Healthcare Provider Details

I. General information

NPI: 1831439728
Provider Name (Legal Business Name): ROBERT JAMES COOPER JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 GRISSOM RD
SAN ANTONIO TX
78251-2805
US

IV. Provider business mailing address

106 N MEADOW ST
CONVERSE TX
78109-2516
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-2958
  • Fax: 210-509-0338
Mailing address:
  • Phone: 210-849-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: