MEDICARE: MRS. DAWN RENEE COOK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2002000530	MO

General Provider Information

NPI Number	:	1912017351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN RENEE COOK RPH

Provider Business Mailing Address
First Line	:	875 DUENKE RD
Second Line	:
City	:	FORISTELL
State	:	MO
Zip	:	63348-1128
Country	:	US
Telephone Number	:	636-448-6527
Fax Number	:	636-925-1295

Provider Business Practice Location Address
First Line	:	2855 VETERANS MEMORIAL PKWY
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3526
Country	:	US
Telephone Number	:	636-925-1143
Fax Number	:	636-925-1295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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