MEDICARE: SETH 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	183700000X	Pharmacy Technician	T061474	AZ

General Provider Information

NPI Number	:	1194657098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH COOK

Provider Business Mailing Address
First Line	:	5155 E EAGLE DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1211
Country	:	US
Telephone Number	:	480-690-9655
Fax Number	:	480-422-8760

Provider Business Practice Location Address
First Line	:	5155 E EAGLE DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1211
Country	:	US
Telephone Number	:	480-690-9655
Fax Number	:	480-422-8760

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ SETH COOK ” Practice Location

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