Individual
REIDE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 PAWTUCKET BLVD UNIT 5, LOWELL, MA 01854-2951
(904) 377-1166
Mailing address
307 PAWTUCKET BLVD UNIT 5, LOWELL, MA 01854-2951
(904) 377-1166
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH240284
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C160739943270
DRIVER'S LICENSE
FL
Enumeration date
11/10/2022
Last updated
11/10/2022
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