Individual
GAYVON COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28042 BRUSH ST, MADISON HTS, MI 48071-2802
(248) 404-8244
Mailing address
28042 BRUSH ST, MADISON HTS, MI 48071-2802
(248) 547-4619
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302032595
MI
Other
Enumeration date
03/05/2009
Last updated
03/05/2009
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