Healthcare Provider Details

I. General information

NPI: 1720191745
Provider Name (Legal Business Name): JOSEPH EDWIN COOK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 CENTRAL AVE
TRION GA
30753-1125
US

IV. Provider business mailing address

228 CENTRAL AVE
TRION GA
30753-1125
US

V. Phone/Fax

Practice location:
  • Phone: 706-734-2221
  • Fax: 706-734-3107
Mailing address:
  • Phone: 706-734-2221
  • Fax: 706-734-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10149
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: