Provider Demographics
NPI:1558012757
Name:COOK, ELLE (RPH)
Entity Type:Individual
Prefix:DR
First Name:ELLE
Middle Name:
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 1:3311 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8664
Mailing Address - Country:US
Mailing Address - Phone:406-529-3479
Mailing Address - Fax:
Practice Address - Street 1:2750 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9741
Practice Address - Country:US
Practice Address - Phone:406-529-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT76193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist