=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871719575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY ALAN COOK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 789 CENTRAL AVE WENTWORTH DOUGLASS HOSPITAL PHARMACY
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-740-2514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 WINKLEY FARM LN
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03867-4265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-867-8929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | R1122
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------