Healthcare Provider Details

I. General information

NPI: 1992635627
Provider Name (Legal Business Name): MARY AMANDA COOK CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 CELANESE RD STE 102
ROCK HILL SC
29732-9406
US

IV. Provider business mailing address

2760 CELANESE RD STE 102
ROCK HILL SC
29732-9406
US

V. Phone/Fax

Practice location:
  • Phone: 803-981-5330
  • Fax: 803-981-5333
Mailing address:
  • Phone: 803-981-5330
  • Fax: 803-981-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number56025
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: