Provider Demographics
NPI:1508969049
Name:SCOTT COOK PHARMACY
Entity Type:Organization
Organization Name:SCOTT COOK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:W,
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-712-2000
Mailing Address - Street 1:1233 WESTGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-712-2000
Mailing Address - Fax:334-712-2002
Practice Address - Street 1:1233 WESTGATE PKWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-712-2000
Practice Address - Fax:334-712-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1124043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51057108OtherBCBS PROVIDER ID
AL51057108OtherBCBS PROVIDER ID