Provider Demographics
NPI:1659440857
Name:COCKMAN, ROBERT GRANDISON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRANDISON
Last Name:COCKMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 BURLINGTON RD STE N
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9262
Mailing Address - Country:US
Mailing Address - Phone:336-446-0099
Mailing Address - Fax:336-446-0094
Practice Address - Street 1:6307 BURLINGTON RD STE N
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9262
Practice Address - Country:US
Practice Address - Phone:336-446-0099
Practice Address - Fax:336-446-0094
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418081Medicaid