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General NPI Number Information
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NPI Number | 1316336761
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Entity Type | Organization
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Legal Business Name | COOPER CLINIC, PA
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 6801 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-4067
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Country | US
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Telephone | 479-274-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-4100
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Country | US
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Telephone | 479-274-2000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CURTIS RALSTON
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Credential |
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Telephone | 479-274-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | E3603
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License Number State | AR
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