Provider Demographics
NPI:1376063073
Name:COBB, AJARVIS (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:AJARVIS
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 SW 115TH AVE APT. 303
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5421
Mailing Address - Country:US
Mailing Address - Phone:904-868-8724
Mailing Address - Fax:
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPS577251835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty