1225048903 NPI number — SCOTT-COOK PHARMACY

Table of content: (NPI 1225048903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225048903 NPI number — SCOTT-COOK PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT-COOK PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225048903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1233 WESTGATE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36303-2151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-712-2000
Provider Business Mailing Address Fax Number:
334-712-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1233 WESTGATE PKWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-712-2000
Provider Business Practice Location Address Fax Number:
334-712-2002
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
W.
Authorized Official Middle Name:
MARVIN
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
334-712-2000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  112404 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009600350 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002489 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51057108 . This is a "PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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