Provider Demographics
NPI:1366047763
Name:COOPER, JESSICA FAYE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FAYE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 TURKEYFOOT RD
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-2840
Mailing Address - Country:US
Mailing Address - Phone:859-647-6211
Mailing Address - Fax:859-647-0486
Practice Address - Street 1:3950 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-2840
Practice Address - Country:US
Practice Address - Phone:859-647-6211
Practice Address - Fax:859-647-0486
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist