Provider Demographics
NPI:1467462176
Name:COX, JEFFREY FRED SR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FRED
Last Name:COX
Suffix:SR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2726
Mailing Address - Country:US
Mailing Address - Phone:229-377-9017
Mailing Address - Fax:229-377-3994
Practice Address - Street 1:300 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2726
Practice Address - Country:US
Practice Address - Phone:229-377-9017
Practice Address - Fax:229-377-3994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011909183500000X
GARPH011909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist