Provider Demographics
NPI:1861043580
Name:COBB'S PHARMACY LLC
Entity Type:Organization
Organization Name:COBB'S PHARMACY LLC
Other - Org Name:PLEASANT'S COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:318-396-1965
Mailing Address - Street 1:903 WARREN DR STE C
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7158
Mailing Address - Country:US
Mailing Address - Phone:318-396-1985
Mailing Address - Fax:
Practice Address - Street 1:903 WARREN DR STE C
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7158
Practice Address - Country:US
Practice Address - Phone:318-396-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy