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General NPI Number Information
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NPI Number | 1922985522
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Entity Type | Individual
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Provider Name | JUSTIN COOPER-NURSE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 81 ROCHESTER RD
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City | MIDDLEPORT
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State | NY
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Zip | 14105-9638
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Country | US
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Telephone | 716-735-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 QUAKER RD
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City | BARKER
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State | NY
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Zip | 14012-9643
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Country | US
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Telephone | 716-370-9536
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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 | 072959
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License Number State | NY
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