Healthcare Provider Details

I. General information

NPI: 1285117622
Provider Name (Legal Business Name): LINDA FAYE COOK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTHSTAR DR
HOLTS SUMMIT MO
65043-1123
US

IV. Provider business mailing address

140 NORTHSTAR DR
HOLTS SUMMIT MO
65043-1123
US

V. Phone/Fax

Practice location:
  • Phone: 573-896-4579
  • Fax: 573-896-4579
Mailing address:
  • Phone: 573-896-4579
  • Fax: 573-896-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: