Provider Demographics
NPI:1427691427
Name:MARTIN-COOPER, ELLEN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:MARTIN-COOPER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6170 DODD RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3012
Mailing Address - Country:US
Mailing Address - Phone:561-723-3506
Mailing Address - Fax:561-683-6972
Practice Address - Street 1:6901 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2511
Practice Address - Country:US
Practice Address - Phone:561-683-6966
Practice Address - Fax:561-683-6972
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist