Provider Demographics
NPI:1427193465
Name:COOK, MERYL LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:LYNN
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 1:4056 CROSSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1122
Mailing Address - Country:US
Mailing Address - Phone:770-974-3131
Mailing Address - Fax:770-975-9735
Practice Address - Street 1:4797 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5339
Practice Address - Country:US
Practice Address - Phone:770-974-3131
Practice Address - Fax:770-975-9735
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist