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General NPI Number Information
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NPI Number | 1972153708
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Entity Type | Organization
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Legal Business Name | COOKE FOOD STORE INC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 3400 KEITH STREET
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City | CLEVELAND
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State | TN
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Zip | 37312
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Country | US
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Telephone | 423-472-6478
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2365
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City | CLEVELAND
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State | TN
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Zip | 37320-2365
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | GINA MARIE MOSER
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Credential |
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Telephone | 423-472-6478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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