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General NPI Number Information
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NPI Number | 1871710715
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Entity Type | Organization
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Legal Business Name | COOK WHOLESALE CO INC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 162 HIGHWAY 13 S
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City | MORTON
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State | MS
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Zip | 39117-3352
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Country | US
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Telephone | 601-732-6334
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Fax | 601-732-7124
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Provider Business Mailing Address
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Address Line | 150 LAKESHORE RD
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City | PELAHATCHIE
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State | MS
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Zip | 39145-2711
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Country | US
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Telephone | 601-732-6334
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Fax | 601-732-7124
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Authorized Official
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Title or Position | CFO
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Name | SARAH ANDERSON
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Credential |
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Telephone | 601-732-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 04573
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License Number State | MS
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