Provider Demographics
NPI:1871895342
Name:COOPER, LANI MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:LANI
Middle Name:MICHELLE
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 1:2513 TWIGHLIGHT RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1675
Mailing Address - Country:US
Mailing Address - Phone:801-634-2000
Mailing Address - Fax:
Practice Address - Street 1:1635 S DON ROSER DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4550
Practice Address - Country:US
Practice Address - Phone:575-522-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5191183500000X
UT5137939-1701183500000X
IDP51921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist