1639224413 NPI number — MR. ELMER ALFRED COOK JR. RPH, MBA

Table of content: MR. ELMER ALFRED COOK JR. RPH, MBA (NPI 1639224413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639224413 NPI number — MR. ELMER ALFRED COOK JR. RPH, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
ELMER
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
RPH, MBA
Provider Gender Code:
M

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:
1639224413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2332
Provider Second Line Business Mailing Address:
1401 NORTH FAIRWAY DR
Provider Business Mailing Address City Name:
SHOW LOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85902-2332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-537-4592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W DEUCE OF CLUBS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOW LOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85901-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-532-5659
Provider Business Practice Location Address Fax Number:
928-532-5656
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  12305 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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