Provider Demographics
NPI:1013008887
Name:COHEN, HERSHEL B (RPH)
Entity Type:Individual
Prefix:MR
First Name:HERSHEL
Middle Name:B
Last Name:COHEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-3303
Mailing Address - Country:US
Mailing Address - Phone:248-332-6840
Mailing Address - Fax:248-332-6841
Practice Address - Street 1:640 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-3303
Practice Address - Country:US
Practice Address - Phone:248-332-6840
Practice Address - Fax:248-332-6841
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI21325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2341561Medicare UPIN