Healthcare Provider Details

I. General information

NPI: 1427106475
Provider Name (Legal Business Name): COOKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S MAIN ST
NEW CASTLE KY
40050
US

IV. Provider business mailing address

PO BOX 708
NEW CASTLE KY
40050-0708
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-2803
  • Fax: 502-845-2834
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07155
License Number StateKY

VIII. Authorized Official

Name: WAYNE SPARROW
Title or Position: VP
Credential: RPH
Phone: 502-532-7388