Provider Demographics
NPI:1124603840
Name:COOK, LISA (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 CEDAR CT NE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-7013
Mailing Address - Country:US
Mailing Address - Phone:812-968-4274
Mailing Address - Fax:
Practice Address - Street 1:13410 EASTPOINT CENTRE DR STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4160
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:877-662-6355
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist