Provider Demographics
NPI:1295029460
Name:COBB, SHAUN M (RPH)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:M
Last Name:COBB
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:201 DATES DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1345
Mailing Address - Country:US
Mailing Address - Phone:607-252-3307
Mailing Address - Fax:607-274-4534
Practice Address - Street 1:201 DATES DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1345
Practice Address - Country:US
Practice Address - Phone:607-252-3307
Practice Address - Fax:607-274-4534
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0407031835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology