Provider Demographics
NPI:1053647669
Name:COCKERHAM, EMILIE K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:K
Last Name:COCKERHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3836
Mailing Address - Country:US
Mailing Address - Phone:817-735-8185
Mailing Address - Fax:817-735-8130
Practice Address - Street 1:4515 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3836
Practice Address - Country:US
Practice Address - Phone:817-735-8185
Practice Address - Fax:817-735-8130
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780699876OtherPHARMACY