Individual
COOPER J O'NEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6202 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3073
(260) 432-5120
Mailing address
3767 SAGAMORE LN APT 219, FORT WAYNE, IN 46845-8218
(765) 860-5135
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
45022189A
IN
Other
Enumeration date
07/30/2024
Last updated
07/30/2024
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