Healthcare Provider Details

I. General information

NPI: 1477751857
Provider Name (Legal Business Name): MICHAEL DEAN COOKSTON PHARMD, R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BOYD AVE
NEWCASTLE WY
82701-2965
US

IV. Provider business mailing address

122 ASH ST
NEWCASTLE WY
82701-3127
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-2741
  • Fax: 307-746-9405
Mailing address:
  • Phone: 307-761-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5551
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3171
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: