Healthcare Provider Details

I. General information

NPI: 1841214848
Provider Name (Legal Business Name): MARK ALLEN COBB R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

5312 GREENWOOD ST
SHAWNEE KS
66216-5183
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 913-248-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10621
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: