Individual
GRANT ANTHONY COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1302 W STATE ROAD 2, LA PORTE, IN 46350-4666
(219) 362-7009
(219) 326-1723
Mailing address
1304 MONROE ST, LA PORTE, IN 46350-3535
(219) 309-7948
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26026808A
IN
Other
Enumeration date
08/13/2016
Last updated
08/13/2016
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