Individual
DR. COREY DEQUAN COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
2200 BERGQUIST DR, SUITE 1, LACKLAND A F B, TX 78236-9907
(210) 292-7216
Mailing address
2200 BERGQUIST DR, SUITE 1, LACKLAND A F B, TX 78236-9907
(210) 292-7216
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
48757
TX
Other
Enumeration date
08/16/2010
Last updated
08/16/2010
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