Basic Information
| Provider Information | |||||||||
| NPI: | 1003291410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | TAMARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10139 157TH ST N | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334789372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615961238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 OLD BOYNTON RD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334366506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617424055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2015 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 36207 | SC | Y | Pharmacy Service Providers | Pharmacist | 183500000X | PS59528 | FL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.