MEDICARE: WILLIAM R COOK PADGETT DRUGS

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH13058	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2009063	OTHER		PK

General Provider Information

NPI Number	:	1831316934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM R COOK PADGETT DRUGS

Provider Business Mailing Address
First Line	:	406 W HIGHWAY 90
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-2520
Country	:	US
Telephone Number	:	850-547-2661
Fax Number	:	850-547-4276

Provider Business Practice Location Address
First Line	:	406 W HIGHWAY 90
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-2520
Country	:	US
Telephone Number	:	850-547-2661
Fax Number	:	850-547-4276

Authorized Official
Title or Position	:	OWNER AND PHRMCST
Name	:	WILLIAM COOK
Credential	:
Telephone Number	:	850-547-2661

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/13/2016

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