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General NPI Number Information
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NPI Number | 1659368439
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Entity Type | Organization
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Legal Business Name | COOLEY APOTHECARY INC
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 128 N LAKE DR
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1270
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Country | US
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Telephone | 606-886-8106
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Fax | 606-886-8148
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Provider Business Mailing Address
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Address Line | PO BOX 166
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City | PRESTONSBURG
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State | KY
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Zip | 41653-0166
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Country | US
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Telephone | 606-886-8106
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Fax | 606-886-8148
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | WANDA K SALYER
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Credential |
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Telephone | 606-886-8106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P01044
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License Number State | KY
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