Provider Demographics
NPI:1104144310
Name:COOK, MICHAEL DUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DUSTIN
Last Name:COOK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MINERAL TRCE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4507
Mailing Address - Country:US
Mailing Address - Phone:205-987-7444
Mailing Address - Fax:
Practice Address - Street 1:509 MINERAL TRCE
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-4507
Practice Address - Country:US
Practice Address - Phone:205-987-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist