Individual
DR. BENJAMIN JESSE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
5425 W CHINDEN BLVD, GARDEN CITY, ID 83714-1468
(208) 323-7036
(208) 323-7036
Mailing address
5425 W CHINDEN BLVD, GARDEN CITY, ID 83714-1468
(208) 323-7036
(208) 323-7036
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6104
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS12296
IDAHO CONTROLLED SUBSTANCE REGISTRATION
ID
01
—
P6104
IDAHO PHARMACIST LICENSE
ID
Enumeration date
04/06/2011
Last updated
04/06/2011
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