Healthcare Provider Details

I. General information

NPI: 1831054949
Provider Name (Legal Business Name): COOPER SCARMARDO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W156N11261 PILGRIM RD
GERMANTOWN WI
53022-3420
US

IV. Provider business mailing address

1129 W SILVER SPRING DR
MILWAUKEE WI
53209-5150
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-9720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23316
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: