1427691427 NPI number — ELLEN MARIE MARTIN-COOPER PHARMD

Table of content: ELLEN MARIE MARTIN-COOPER PHARMD (NPI 1427691427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427691427 NPI number — ELLEN MARIE MARTIN-COOPER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN-COOPER
Provider First Name:
ELLEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
ELLEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427691427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6170 DODD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-723-3506
Provider Business Mailing Address Fax Number:
561-683-6972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6901 OKEECHOBEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-683-6966
Provider Business Practice Location Address Fax Number:
561-683-6972
Provider Enumeration Date:
10/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS37772 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com