Provider Demographics
NPI:1922637685
Name:COOK, PATRICIA KATHLEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:COOK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HANNAH LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7025
Mailing Address - Country:US
Mailing Address - Phone:239-281-3633
Mailing Address - Fax:
Practice Address - Street 1:1021 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4718
Practice Address - Country:US
Practice Address - Phone:407-644-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist