Healthcare Provider Details

I. General information

NPI: 1851434666
Provider Name (Legal Business Name): JESSICA RUTH ANNE COOK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RUTH ANNE KILGORE

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N. GATEWAY AVE
ROCKWOOD TN
37854
US

IV. Provider business mailing address

255 WMA RD
ROCKWOOD TN
37854-3521
US

V. Phone/Fax

Practice location:
  • Phone: 865-354-0234
  • Fax: 865-354-8381
Mailing address:
  • Phone: 865-567-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: