Provider Demographics
NPI:1346569415
Name:COOK, DEBORAH KAY (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
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 1:103 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56096-1444
Mailing Address - Country:US
Mailing Address - Phone:507-362-8500
Mailing Address - Fax:
Practice Address - Street 1:103 3RD ST S
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:MN
Practice Address - Zip Code:56096-1444
Practice Address - Country:US
Practice Address - Phone:507-362-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist