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General NPI Number Information
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NPI Number | 1326648825
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Entity Type | Individual
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Provider Name | CODY M COOPER CPHT
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 12815 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79423-5677
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Country | US
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Telephone | 806-776-8915
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 19TH ST APT 1603
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City | LUBBOCK
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State | TX
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Zip | 79407-1376
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Country | US
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Telephone | 806-778-7935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 217641
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PT00011253
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License Number State | NM
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