Provider Demographics
NPI:1083835946
Name:COOK, PATRICK MANNING (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MANNING
Last Name:COOK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 369
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:GA
Mailing Address - Zip Code:30113
Mailing Address - Country:US
Mailing Address - Phone:770-646-3570
Mailing Address - Fax:770-646-3571
Practice Address - Street 1:406 CARROLLTON ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113
Practice Address - Country:US
Practice Address - Phone:770-646-3570
Practice Address - Fax:770-646-3571
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH020833OtherSTATE LICENSE NO.