Provider Demographics
NPI:1356472856
Name:COOK, STEVEN TRENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:TRENT
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 1:967 REGIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3551
Mailing Address - Country:US
Mailing Address - Phone:662-513-7912
Mailing Address - Fax:662-234-1699
Practice Address - Street 1:967 REGIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3551
Practice Address - Country:US
Practice Address - Phone:662-513-7912
Practice Address - Fax:662-234-1699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist