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General NPI Number Information
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NPI Number | 1679296446
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Entity Type | Individual
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Provider Name | KELLEY COOK
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Gender | Female
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 3157 NATIONAL PIKE
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City | RICHEYVILLE
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State | PA
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Zip | 15358-1004
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Country | US
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Telephone | 724-632-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 COUNTRY VIEW LN
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City | MORGANTOWN
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State | WV
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Zip | 26505-1527
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Country | US
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Telephone | 302-216-1878
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Fax |
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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 | RP448546
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License Number State | PA
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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 | 58443
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP5121
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License Number State | WV
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