Provider Demographics
NPI:1558638536
Name:COOK, TRACEY CAROLINE (PHARMD, MSCR)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:CAROLINE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHARMD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 WAY
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320
Mailing Address - Country:US
Mailing Address - Phone:336-616-0196
Mailing Address - Fax:336-342-6241
Practice Address - Street 1:1623 WAY
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-616-0196
Practice Address - Fax:336-342-6241
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist