Healthcare Provider Details

I. General information

NPI: 1194473777
Provider Name (Legal Business Name): RONALD EXLEY COOK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 US HIGHWAY 80 W
GARDEN CITY GA
31408-3108
US

IV. Provider business mailing address

523 DRESLER RD
RINCON GA
31326-4749
US

V. Phone/Fax

Practice location:
  • Phone: 912-966-1416
  • Fax: 912-966-1417
Mailing address:
  • Phone: 912-667-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH011107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: