Provider Demographics
NPI:1083938245
Name:COCHRAN, GREGORY ANTHONY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANTHONY
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3927
Mailing Address - Country:US
Mailing Address - Phone:618-659-7339
Mailing Address - Fax:618-659-7340
Practice Address - Street 1:5 ILLINI DR
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3927
Practice Address - Country:US
Practice Address - Phone:618-659-7339
Practice Address - Fax:618-659-7340
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011011747183500000X
IL051.292675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist