Provider Demographics
NPI:1821171398
Name:COOK, SR, WILLIAM MARVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARVIN
Last Name:COOK, SR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 FOWLER RD
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36312-6232
Mailing Address - Country:US
Mailing Address - Phone:334-899-3100
Mailing Address - Fax:334-899-3186
Practice Address - Street 1:430 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:AL
Practice Address - Zip Code:36312
Practice Address - Country:US
Practice Address - Phone:334-899-3100
Practice Address - Fax:334-899-3186
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist