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General NPI Number Information
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NPI Number | 1356686208
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Entity Type | Individual
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Provider Name | MR. WADE HAMPTON COBB III
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Gender | Male
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 7320 BROAD RIVER RD
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City | IRMO
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State | SC
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Zip | 29063-9656
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Country | US
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Telephone | 803-407-0127
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Fax | 863-284-3349
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Provider Business Mailing Address
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Address Line | 312 WHITEFORD WAY
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City | LEXINGTON
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State | SC
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Zip | 29072-7975
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Country | US
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Telephone | 803-216-5996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6322
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License Number State | SC
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