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General NPI Number Information
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NPI Number | 1053694562
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Entity Type | Individual
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Provider Name | LARRY JEFFREY COOK RPH
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 1920 N LAKOTA DR UNIT 62
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City | SAINT GEORGE
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State | UT
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Zip | 84770-7441
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Country | US
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Telephone | 435-272-4767
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Fax | 435-272-4676
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Provider Business Mailing Address
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Address Line | 1920 N LAKOTA DR UNIT 62
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City | SAINT GEORGE
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State | UT
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Zip | 84770-7441
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Country | US
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Telephone | 435-272-4767
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Fax | 435-272-4676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH008757
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2696
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License Number State | WY
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