Provider Demographics
NPI:1548586043
Name:COCHRAN, MICHAEL ARTHUR (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 155
Mailing Address - Street 2:
Mailing Address - City:SHOBONIER
Mailing Address - State:IL
Mailing Address - Zip Code:62885-9730
Mailing Address - Country:US
Mailing Address - Phone:618-846-3032
Mailing Address - Fax:
Practice Address - Street 1:1006 N KELLER DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1743
Practice Address - Country:US
Practice Address - Phone:217-347-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist