Healthcare Provider Details

I. General information

NPI: 1649592056
Provider Name (Legal Business Name): JEANNE MARIE COOK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 ROUTE 209
WURTSBORO NY
12790
US

IV. Provider business mailing address

PO BOX 897
WURTSBORO NY
12790-0897
US

V. Phone/Fax

Practice location:
  • Phone: 845-888-2614
  • Fax:
Mailing address:
  • Phone: 845-888-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: