Provider Demographics
NPI:1164968186
Name:COCHRAN, CONSTANCE FAITH
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:FAITH
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 MUSIC MILL RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2542
Mailing Address - Country:US
Mailing Address - Phone:770-537-9501
Mailing Address - Fax:770-537-6963
Practice Address - Street 1:2865 MUSIC MILL RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2542
Practice Address - Country:US
Practice Address - Phone:770-537-9501
Practice Address - Fax:770-537-6963
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist