Provider Demographics
NPI:1306298435
Name:COOK, KAYLA J
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:6347 GLASS FACTORY RD
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-0391
Mailing Address - Country:US
Mailing Address - Phone:315-404-6594
Mailing Address - Fax:
Practice Address - Street 1:4855 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6212
Practice Address - Country:US
Practice Address - Phone:315-736-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist