Provider Demographics
NPI:1225048903
Name:SCOTT-COOK PHARMACY
Entity Type:Organization
Organization Name:SCOTT-COOK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-712-2000
Mailing Address - Street 1:1233 WESTGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2151
Mailing Address - Country:US
Mailing Address - Phone:334-712-2000
Mailing Address - Fax:334-712-2002
Practice Address - Street 1:1233 WESTGATE PKWY.
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-712-2000
Practice Address - Fax:334-712-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112404333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009600350Medicaid
AL100002489Medicaid
AL51057108OtherPROVIDER