Active NPI
Derrick Christopher Cooper, RPH
- Pharmacist
- Palm Coast, FL
National Provider Identifier
1174854699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS 43069
- Practice address
- 111 Flagler Plaza Dr
Palm Coast, FL 32137-5967 - Phone
- (386) 517-0010
- Fax
- (386) 439-6850
- NPI assigned
- Jan 22, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS 43069 | FL | Primary |
| Pharmacist | 183500000X | 043376 | NY |
Addresses
Primary practice location
111 Flagler Plaza Dr
Palm Coast, FL 32137-5967
Mailing address
111 Flagler Plaza Dr
Palm Coast, FL 32137-5967
Phone (386) 517-0010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS 43069 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1174854699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 FLAGLER PLAZA DR",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321375967",
"telephone_number": "386-517-0010",
"fax_number": "386-439-6850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 FLAGLER PLAZA DR",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321375967",
"telephone_number": "386-517-0010",
"fax_number": "386-439-6850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "DERRICK",
"middle_name": "CHRISTOPHER",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-22",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS 43069",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "043376",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.