Healthcare Provider Details

I. General information

NPI: 1922718634
Provider Name (Legal Business Name): WESLEY COOPER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10142 HUEBNER RD
SAN ANTONIO TX
78240-1372
US

IV. Provider business mailing address

10142 HUEBNER RD
SAN ANTONIO TX
78240-1372
US

V. Phone/Fax

Practice location:
  • Phone: 210-998-2671
  • Fax: 210-998-2672
Mailing address:
  • Phone: 210-998-2671
  • Fax: 210-998-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57264
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number451609
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number57264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: