Healthcare Provider Details

I. General information

NPI: 1942296587
Provider Name (Legal Business Name): BARRY J. COOK PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 BERESFORD WAY
LAKE MARY FL
32746-6435
US

IV. Provider business mailing address

913 BERESFORD WAY
LAKE MARY FL
32746-6435
US

V. Phone/Fax

Practice location:
  • Phone: 407-321-9711
  • Fax: 407-792-6125
Mailing address:
  • Phone: 407-321-9711
  • Fax: 407-792-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number28RIO1372300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: