Provider Demographics
NPI:1336888023
Name:COOK CHILDRENS MEDICAL CENTER - PROSPER
Entity Type:Organization
Organization Name:COOK CHILDRENS MEDICAL CENTER - PROSPER
Other - Org Name:COOK CHILDREN'S RETAIL PHARMACY - PROSPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-885-4480
Mailing Address - Street 1:PO BOX 730108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0108
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4200 W UNIVERSITY DRIVE
Practice Address - Street 2:STE 160
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:682-885-4000
Practice Address - Fax:682-885-1903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDRENS MEDICAL CENTER - PROSPER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy