Provider Demographics
NPI:1326069881
Name:COBLE, VAN G (DPH, CDM, FASCP)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:G
Last Name:COBLE
Suffix:
Gender:M
Credentials:DPH, CDM, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-4715
Mailing Address - Country:US
Mailing Address - Phone:620-221-9190
Mailing Address - Fax:620-221-3296
Practice Address - Street 1:722 WHEAT RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3216
Practice Address - Country:US
Practice Address - Phone:620-221-7850
Practice Address - Fax:620-221-3296
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist