MEDICARE: COREY CLAY 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	RPH023282	GA

General Provider Information

NPI Number	:	1821685132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY CLAY COOPER PHARMD

Provider Business Mailing Address
First Line	:	300 2ND AVE SE
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-2726
Country	:	US
Telephone Number	:	229-377-9017
Fax Number	:	229-377-3994

Provider Business Practice Location Address
First Line	:	300 2ND AVE SE
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-2726
Country	:	US
Telephone Number	:	229-377-9017
Fax Number	:	229-377-3994

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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Directions to “ COREY CLAY COOPER PHARMD” Practice Location

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