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NPI Code Detail

MEDICARE: KRISTIN COOPER

MEDICARE:   KRISTIN  COOPER
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
1183500000XPharmacist029711GA

General Provider Information

NPI Number : 1245831932
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN COOPER
Provider Business Mailing Address
First Line : 5736 SCREECH OWL DR
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-1203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4221 ATLANTA HWY
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7316
Country : US
Telephone Number : 678-863-7373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2020
Last Update Date : 11/08/2020

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Directions to “ KRISTIN COOPER ” Practice Location

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