MEDICARE: JOHN 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
1	183500000X	Pharmacist	S007661	AZ

General Provider Information

NPI Number	:	1194143941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN COOK

Provider Business Mailing Address
First Line	:	6310 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3538
Country	:	US
Telephone Number	:	520-514-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3538
Country	:	US
Telephone Number	:	520-514-4301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	03/30/2014

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Directions to “ JOHN COOK ” Practice Location

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