Provider Demographics
NPI:1013060094
Name:COOK, KIMBERLEE KAY (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:KAY
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 1:14221 MOUNT MORIAH AVE
Mailing Address - Street 2:
Mailing Address - City:DONNELLSON
Mailing Address - State:IL
Mailing Address - Zip Code:62019-2122
Mailing Address - Country:US
Mailing Address - Phone:217-537-3409
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1432
Practice Address - Country:US
Practice Address - Phone:217-532-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist