Provider Demographics
NPI:1275722191
Name:COOK, ROBERT DENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DENNIS
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 1:27759 EAST SIDE DRIVE
Mailing Address - Street 2:PO BOX 138
Mailing Address - City:BEAVER ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49782
Mailing Address - Country:US
Mailing Address - Phone:231-448-2472
Mailing Address - Fax:
Practice Address - Street 1:301 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist