Provider Demographics
NPI:1609151562
Name:COOKS, ERIC JAMES JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:COOKS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 CAMELLIA LN NE UNIT 1153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6286
Mailing Address - Country:US
Mailing Address - Phone:321-279-7580
Mailing Address - Fax:
Practice Address - Street 1:2450 CAMELLIA LN NE UNIT 1153
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-6286
Practice Address - Country:US
Practice Address - Phone:321-279-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist