Provider Demographics
NPI:1053694562
Name:COOK, LARRY JEFFREY (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JEFFREY
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 1:1920 N LAKOTA DR UNIT 62
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7441
Mailing Address - Country:US
Mailing Address - Phone:435-272-4767
Mailing Address - Fax:435-272-4676
Practice Address - Street 1:1920 N LAKOTA DR UNIT 62
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7441
Practice Address - Country:US
Practice Address - Phone:435-272-4767
Practice Address - Fax:435-272-4676
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008757183500000X
WY2696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist