Provider Demographics
NPI:1336219294
Name:COOK, TOMMIE LYNN (MS, RPH)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PLANTATION DR S
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4113
Mailing Address - Country:US
Mailing Address - Phone:817-733-1545
Mailing Address - Fax:
Practice Address - Street 1:1631 LANCASTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3585
Practice Address - Country:US
Practice Address - Phone:817-310-7027
Practice Address - Fax:817-310-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX267101835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology