Provider Demographics
NPI:1477685717
Name:COOKS PHARMACY INC.
Entity Type:Organization
Organization Name:COOKS PHARMACY INC.
Other - Org Name:DURHAM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DIRECTOR OF PHARMACY
Authorized Official - Phone:205-695-9611
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-0509
Mailing Address - Country:US
Mailing Address - Phone:205-695-9611
Mailing Address - Fax:205-695-7455
Practice Address - Street 1:44801 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5647
Practice Address - Country:US
Practice Address - Phone:205-695-9611
Practice Address - Fax:205-695-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102740333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101232OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL100000009Medicaid
AL100000009Medicaid