Provider Demographics
NPI:1851418818
Name:COOK, THOMAS M (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:COOK
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 1:5724 N LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2746
Mailing Address - Country:US
Mailing Address - Phone:563-386-2087
Mailing Address - Fax:
Practice Address - Street 1:3019 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-2065
Practice Address - Country:US
Practice Address - Phone:563-322-7573
Practice Address - Fax:563-322-3017
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist