Provider Demographics
NPI:1194006692
Name:COOK, KELLY T (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:T
Last Name:COOK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WEST ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2453
Mailing Address - Country:US
Mailing Address - Phone:603-357-1002
Mailing Address - Fax:603-352-6974
Practice Address - Street 1:440 WEST ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2453
Practice Address - Country:US
Practice Address - Phone:603-357-1002
Practice Address - Fax:603-352-6974
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist