Healthcare Provider Details

I. General information

NPI: 1124204391
Provider Name (Legal Business Name): JAMES NEAL COOK DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HYW 491 NORTHERN NAVAJO MEDICAL CENTER
SHIPROCK NM
87420-0160
US

IV. Provider business mailing address

1507 MEADOWS DRIVE
CORINTH MS
38834
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-7250
  • Fax:
Mailing address:
  • Phone: 901-219-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6284
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: