Provider Demographics
NPI:1699048819
Name:COOPER, TABATHA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TABATHA
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 N LEXINGTON SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3808
Mailing Address - Country:US
Mailing Address - Phone:419-529-2487
Mailing Address - Fax:419-529-5193
Practice Address - Street 1:359 N LEXINGTON SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-3808
Practice Address - Country:US
Practice Address - Phone:419-529-2487
Practice Address - Fax:419-529-5193
Is Sole Proprietor?:No
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist