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NPI Code Detail

MEDICARE: DR. BENJAMIN JESSE COOK PHARMD

MEDICARE: DR. BENJAMIN JESSE COOK PHARMD
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
1183500000XPharmacistP6104ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS12296OTHERIDIDAHO CONTROLLED SUBSTANCE REGISTRATION
2P6104OTHERIDIDAHO PHARMACIST LICENSE

General Provider Information

NPI Number : 1992094304
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN JESSE COOK PHARMD
Provider Business Mailing Address
First Line : 5425 W CHINDEN BLVD
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1468
Country : US
Telephone Number : 208-323-7036
Fax Number : 208-323-7036
Provider Business Practice Location Address
First Line : 5425 W CHINDEN BLVD
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1468
Country : US
Telephone Number : 208-323-7036
Fax Number : 208-323-7036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2011
Last Update Date : 04/06/2011

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