Healthcare Provider Details

I. General information

NPI: 1124603840
Provider Name (Legal Business Name): LISA COOK PHARM. D., R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 EASTPOINT CENTRE DR STE 101
LOUISVILLE KY
40223-4160
US

IV. Provider business mailing address

1774 CEDAR CT NE
CORYDON IN
47112-7013
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax: 877-662-6355
Mailing address:
  • Phone: 812-968-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010716
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: