Healthcare Provider Details

I. General information

NPI: 1891721205
Provider Name (Legal Business Name): COOKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 S PENN AVE
EMINENCE KY
40019-1036
US

IV. Provider business mailing address

42 S PENN AVE
EMINENCE KY
40019-1036
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-4216
  • Fax: 502-845-7922
Mailing address:
  • Phone: 502-845-4216
  • Fax: 502-845-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01419
License Number StateKY

VIII. Authorized Official

Name: GEORGE MCDANNOLD
Title or Position: N/A
Credential: RPH
Phone: 502-845-4216