MEDICARE: DANIEL COOKE

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	019598	KY

General Provider Information

NPI Number	:	1235635988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL COOKE

Provider Business Mailing Address
First Line	:	330 N MAIN ST
Second Line	:
City	:	SMITHS GROVE
State	:	KY
Zip	:	42171-8226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S MAIN ST
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9001
Country	:	US
Telephone Number	:	270-597-1044
Fax Number	:

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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Directions to “ DANIEL COOKE ” Practice Location

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