Healthcare Provider Details

I. General information

NPI: 1821171398
Provider Name (Legal Business Name): WILLIAM MARVIN COOK, SR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BROADWAY ST
ASHFORD AL
36312
US

IV. Provider business mailing address

143 FOWLER RD
ASHFORD AL
36312-6232
US

V. Phone/Fax

Practice location:
  • Phone: 334-899-3100
  • Fax: 334-899-3186
Mailing address:
  • Phone: 334-899-3100
  • Fax: 334-899-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7973
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: