Healthcare Provider Details

I. General information

NPI: 1972615821
Provider Name (Legal Business Name): COOKE DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S JEFFERSON
SIGOURNEY IA
52591
US

IV. Provider business mailing address

105 S JEFFERSON
SIGOURNEY IA
52591
US

V. Phone/Fax

Practice location:
  • Phone: 641-622-3020
  • Fax: 641-622-3020
Mailing address:
  • Phone: 641-622-3020
  • Fax: 641-622-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number171
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL EDWARD O'ROURKE
Title or Position: PHARMACIST OWNER
Credential:
Phone: 641-622-3020