Healthcare Provider Details

I. General information

NPI: 1760575104
Provider Name (Legal Business Name): COOK DISCOUNT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5324 BROWN ST
GRACEVILLE FL
32440
US

IV. Provider business mailing address

5324 BROWN ST
GRACEVILLE FL
32440-2238
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-4110
  • Fax: 850-263-3125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH6634
License Number StateFL

VIII. Authorized Official

Name: KEVIN ALLEN TAYLOR
Title or Position: OWNER
Credential:
Phone: 850-263-4110