Healthcare Provider Details

I. General information

NPI: 1457337008
Provider Name (Legal Business Name): WILLIAM R. COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W HIGHWAY 90
BONIFAY FL
32425-2520
US

IV. Provider business mailing address

406 W HIGHWAY 90
BONIFAY FL
32425-2520
US

V. Phone/Fax

Practice location:
  • Phone: 850-547-2661
  • Fax: 850-547-4276
Mailing address:
  • Phone: 850-547-2661
  • Fax: 850-547-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: