Provider Demographics
NPI:1407183445
Name:COOK, BRYAN PAUL (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:PAUL
Last Name:COOK
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 S SOSSAMAN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3400
Mailing Address - Country:US
Mailing Address - Phone:480-333-6559
Mailing Address - Fax:480-333-6556
Practice Address - Street 1:1444 S SOSSAMAN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3400
Practice Address - Country:US
Practice Address - Phone:480-333-6559
Practice Address - Fax:480-333-6556
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO13947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist