Provider Demographics
NPI:1265815344
Name:COBB, STEPHEN WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:COBB
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 1:38 N TRADE ST
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-6656
Mailing Address - Country:US
Mailing Address - Phone:828-859-9181
Mailing Address - Fax:828-859-9271
Practice Address - Street 1:38 N TRADE ST
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6656
Practice Address - Country:US
Practice Address - Phone:828-859-9181
Practice Address - Fax:828-859-9271
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist