Edwin Garrick Cooper
Individual provider Active NPI Pharmacist · Spencer, IN
NPI 1295335776 · NPPES record last updated Oct 26, 2020
Key facts
- NPI
- 1295335776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26020898A (IN)
- Practice address
- 823 W State Highway 46
Spencer, IN 47460-6748 - Phone
- (812) 829-2289
- Fax
- (812) 829-6412
- NPI assigned
- Oct 26, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26020898A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past |
Accepting new patients | |
| Wal-Mart Stores East LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26020898A | IN | Yes |
Addresses
Primary practice location
823 W State Highway 46
Spencer, IN 47460-6748
Mailing address
884 S Deer Run
Ellettsville, IN 47429-2041
Phone (812) 325-4925
Other providers in Spencer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.