Provider Demographics
NPI:1124373741
Name:COOK, CRYSTAL CAMILLE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CAMILLE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 US HIGHWAY 84 E
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1647
Mailing Address - Country:US
Mailing Address - Phone:229-377-7644
Mailing Address - Fax:
Practice Address - Street 1:496 US HIGHWAY 84 E
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-1647
Practice Address - Country:US
Practice Address - Phone:229-377-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist