Provider Demographics
NPI:1194473777
Name:COOK, RONALD EXLEY (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EXLEY
Last Name:COOK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 DRESLER RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-4749
Mailing Address - Country:US
Mailing Address - Phone:912-667-0342
Mailing Address - Fax:
Practice Address - Street 1:516 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-3108
Practice Address - Country:US
Practice Address - Phone:912-966-1416
Practice Address - Fax:912-966-1417
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist