Individual provider Active NPI

Kevin Wade Cook, PHARMACIST

  • Pharmacist
  • Dyersburg, TN
National Provider Identifier
1124170816
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
21780 Issued in TN
Practice address
2490 Parr Ave Ste 9
Dyersburg, TN 38024-2030
Phone
(731) 285-0844
Fax
(731) 285-0885
NPI assigned
Jan 16, 2007
Last updated
Apr 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 21780 TN Primary

Addresses

Primary practice location

2490 Parr Ave Ste 9
Dyersburg, TN 38024-2030

Mailing address

2301 Westwood CV
Dyersburg, TN 38024-5284
Phone (731) 285-0844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
21780TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
BCP 1, LLC PastSince Jan 1, 2021 Accepting new patients
C & C Pharmacy, LLC PastSince Aug 10, 2010 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1124170816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 WESTWOOD CV",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380245284",
            "telephone_number": "731-285-0844",
            "fax_number": "731-285-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 PARR AVE STE 9",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242030",
            "telephone_number": "731-285-0844",
            "fax_number": "731-285-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "KEVIN",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "21780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.