Healthcare Provider Details

I. General information

NPI: 1659440857
Provider Name (Legal Business Name): ROBERT GRANDISON COCKMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 BURLINGTON RD STE N
WHITSETT NC
27377-9262
US

IV. Provider business mailing address

6307 BURLINGTON RD STE N
WHITSETT NC
27377-9262
US

V. Phone/Fax

Practice location:
  • Phone: 336-446-0099
  • Fax: 336-446-0094
Mailing address:
  • Phone: 336-446-0099
  • Fax: 336-446-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: