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General NPI Number Information
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NPI Number | 1104952183
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Entity Type | Organization
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Legal Business Name | COOLEY DRUG INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 310 MISSISSIPPI DR
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City | WAYNESBORO
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State | MS
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Zip | 39367-2810
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Country | US
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Telephone | 601-735-2227
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Fax | 601-735-0391
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Provider Business Mailing Address
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Address Line | 310 MISSISSIPPI DR
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City | WAYNESBORO
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State | MS
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Zip | 39367-2810
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Country | US
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Telephone | 601-735-2227
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Fax | 601-735-0391
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Authorized Official
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Title or Position | PHARMACIST AND OWNER
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Name | MR. JAMES K COOLEY
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Credential | RPH
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Telephone | 601-735-4022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 01659011
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License Number State | MS
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