Provider Demographics
NPI:1205030210
Name:COOKS, MADGE SANDERS (RPH)
Entity Type:Individual
Prefix:MS
First Name:MADGE
Middle Name:SANDERS
Last Name:COOKS
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 1:700 31ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2049
Mailing Address - Country:US
Mailing Address - Phone:912-398-5847
Mailing Address - Fax:
Practice Address - Street 1:1290 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1976
Practice Address - Country:US
Practice Address - Phone:877-782-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015709183500000X
SC07421183500000X
FLPS 24271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist