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NPI Code Detail

MEDICARE: AMANDA L COOK

MEDICARE: AMANDA L COOK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2012020929MO

General Provider Information

NPI Number : 1003429580
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA L COOK
Provider Business Mailing Address
First Line : 100 N GRAND AVE
Second Line :
City : HOUSTON
State : MO
Zip : 65483-1222
Country : US
Telephone Number : 417-260-2384
Fax Number :
Provider Business Practice Location Address
First Line : 100 N GRAND AVE
Second Line :
City : HOUSTON
State : MO
Zip : 65483-1222
Country : US
Telephone Number : 417-260-2384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2020
Last Update Date : 08/25/2020

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Directions to “ AMANDA L COOK ” Practice Location

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