Provider Demographics
NPI:1598646879
Name:COOK, NOLAN R
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:R
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 REVOLUTION DR STE 1010
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1582
Mailing Address - Country:US
Mailing Address - Phone:857-282-0165
Mailing Address - Fax:
Practice Address - Street 1:399 REVOLUTION DR STE 1010
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1582
Practice Address - Country:US
Practice Address - Phone:857-282-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH267481835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care