Provider Demographics
NPI:1649688649
Name:COOK, JAMIE (RPH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
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 1:1417 N KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2444
Mailing Address - Country:US
Mailing Address - Phone:620-626-4234
Mailing Address - Fax:620-629-2010
Practice Address - Street 1:1417 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2444
Practice Address - Country:US
Practice Address - Phone:620-626-4234
Practice Address - Fax:620-629-2010
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist