MEDICARE: JILL COOPER PHARMACIST

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	RPH018055	GA

General Provider Information

NPI Number	:	1992454979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL COOPER PHARMACIST

Provider Business Mailing Address
First Line	:	300 LEE ROAD 147
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36804-3809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9220 MARNE RD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5515
Country	:	US
Telephone Number	:	706-544-1049
Fax Number	:

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

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	03/18/2022

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Directions to “ JILL COOPER PHARMACIST” Practice Location

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