Individual
EBONY COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4060 RYAN ST, LAKE CHARLES, LA 70605-2841
(337) 478-9197
Mailing address
2863 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70506-5905
(337) 406-8806
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
019117
LA
Other
Enumeration date
09/21/2011
Last updated
09/03/2015
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