MEDICARE: JONATHAN COBB PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P2201X	Ambulatory Care Pharmacist	41358	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41358	OTHER	TN	TENNESSEE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1851869531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN COBB PHARMD

Provider Business Mailing Address
First Line	:	5410 ILLINOIS AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 ILLINOIS AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2115
Country	:	US
Telephone Number	:	731-499-3336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2018
Last Update Date	:	11/11/2018

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