Provider Demographics
NPI:1669471850
Name:COOK'S PHARMACY OF KINGSTON INC
Entity Type:Organization
Organization Name:COOK'S PHARMACY OF KINGSTON INC
Other - Org Name:COOKS PHARMACY OF KINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-3633
Mailing Address - Street 1:777 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3863
Mailing Address - Country:US
Mailing Address - Phone:570-288-3633
Mailing Address - Fax:570-714-8018
Practice Address - Street 1:777 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3863
Practice Address - Country:US
Practice Address - Phone:570-288-3633
Practice Address - Fax:570-714-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410471L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2078768OtherPK
PA1141160001Medicare NSC