Provider Demographics
NPI:1598049595
Name:COOK, GARY WALTER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WALTER
Last Name:COOK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 W NORTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4412
Mailing Address - Country:US
Mailing Address - Phone:410-764-9570
Mailing Address - Fax:410-764-9519
Practice Address - Street 1:4025 W NORTHERN PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4412
Practice Address - Country:US
Practice Address - Phone:410-764-9570
Practice Address - Fax:410-764-9519
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist