Provider Demographics
NPI:1407939903
Name:COOK, ROSS THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:THOMAS
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 1:759 GRAY RD SE
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-8248
Mailing Address - Country:US
Mailing Address - Phone:231-369-2516
Mailing Address - Fax:231-314-5900
Practice Address - Street 1:2772 GARFIELD RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5004
Practice Address - Country:US
Practice Address - Phone:231-922-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist