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General NPI Number Information
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NPI Number | 1679861892
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Entity Type | Individual
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Provider Name | CLAY M COOPER PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 200 W MAIN ST
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City | JACKSON
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State | TN
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Zip | 38301-6114
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Country | US
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Telephone | 731-265-6555
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Fax | 731-265-6558
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Provider Business Mailing Address
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Address Line | 1392 HIGH SCHOOL RD
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City | SELMER
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State | TN
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Zip | 38375-2342
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Country | US
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Telephone | 731-608-0513
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35721
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License Number State | TN
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