MEDICARE: BRIAN EUGENE COBB RPH

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	62025	CA

General Provider Information

NPI Number	:	1649677741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN EUGENE COBB RPH

Provider Business Mailing Address
First Line	:	1906 VISTA DEL LAGO DR
Second Line	:	SUITE G.
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9700
Country	:	US
Telephone Number	:	209-980-3299
Fax Number	:	209-920-3391

Provider Business Practice Location Address
First Line	:	1906 VISTA DEL LAGO DR
Second Line	:	SUITE G.
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9700
Country	:	US
Telephone Number	:	209-980-3299
Fax Number	:	209-920-3391

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

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	12/04/2014

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