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General NPI Number Information
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NPI Number | 1730534710
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Entity Type | Organization
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Legal Business Name | COBALT PHARMACY, INC.
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 7135 STATE ROAD 52 UNIT 103
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City | HUDSON
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State | FL
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Zip | 34667-6782
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Country | US
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Telephone | 727-378-3598
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Fax | 888-347-2413
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Provider Business Mailing Address
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Address Line | 14194 OAK KNOLL ST
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City | SPRING HILL
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State | FL
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Zip | 34609-3158
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Country | US
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Telephone | 352-232-0839
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Fax | 888-347-2413
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Authorized Official
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Title or Position | CEO
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Name | MR. THEODORE KENNETH FERGUSON II
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Credential |
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Telephone | 352-232-0839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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