MEDICARE: CHARLES COOPER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PR27902	ME

General Provider Information

NPI Number	:	1063898419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES COOPER PHARMD

Provider Business Mailing Address
First Line	:	575 LISBON ST
Second Line	:
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 LISBON ST
Second Line	:
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-1114
Country	:	US
Telephone Number	:	207-353-4843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2015
Last Update Date	:	08/08/2015

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Directions to “ CHARLES COOPER PHARMD” Practice Location

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