Provider Demographics
NPI:1356686208
Name:COBB, WADE HAMPTON III
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:HAMPTON
Last Name:COBB
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WHITEFORD WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7975
Mailing Address - Country:US
Mailing Address - Phone:803-216-5996
Mailing Address - Fax:
Practice Address - Street 1:7320 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9656
Practice Address - Country:US
Practice Address - Phone:803-407-0127
Practice Address - Fax:863-284-3349
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist