MEDICARE: GLENN COHEN

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	183500000X	Pharmacist	6079	SC

General Provider Information

NPI Number	:	1447539846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN COHEN

Provider Business Mailing Address
First Line	:	730 ATLANTIC ST
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-4466
Country	:	US
Telephone Number	:	843-224-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 ATLANTIC ST
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-4466
Country	:	US
Telephone Number	:	843-224-3557
Fax Number	:

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

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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