Provider Demographics
NPI:1275865701
Name:COOK, DONNA SHENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SHENA
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 1:2260 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3843
Mailing Address - Country:US
Mailing Address - Phone:423-479-8601
Mailing Address - Fax:423-476-4793
Practice Address - Street 1:2260 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3843
Practice Address - Country:US
Practice Address - Phone:423-479-8601
Practice Address - Fax:423-476-4793
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist