Provider Demographics
NPI:1720191745
Name:COOK, JOSEPH EDWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWIN
Last Name:COOK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1125
Mailing Address - Country:US
Mailing Address - Phone:706-734-2221
Mailing Address - Fax:706-734-3107
Practice Address - Street 1:228 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1125
Practice Address - Country:US
Practice Address - Phone:706-734-2221
Practice Address - Fax:706-734-3107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3898470001Medicare ID - Type Unspecified