Provider Demographics
NPI:1851422323
Name:COOLEY DRUG INC
Entity Type:Organization
Organization Name:COOLEY DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-735-4022
Mailing Address - Street 1:310 MISSISSIPPI DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2810
Mailing Address - Country:US
Mailing Address - Phone:601-735-4022
Mailing Address - Fax:601-735-0391
Practice Address - Street 1:310 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2810
Practice Address - Country:US
Practice Address - Phone:601-735-4022
Practice Address - Fax:601-735-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01659011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4227170001Medicare NSC