Provider Demographics
NPI:1891386397
Name:COOK, AMY (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-4107
Mailing Address - Country:US
Mailing Address - Phone:570-819-4164
Mailing Address - Fax:
Practice Address - Street 1:16 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:HANOVER TWP
Practice Address - State:PA
Practice Address - Zip Code:18706-4107
Practice Address - Country:US
Practice Address - Phone:570-819-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038304L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA186-86-7249Medicaid