Provider Demographics
NPI:1881205896
Name:COHEN, MATTHEW BRADLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRADLEY
Last Name:COHEN
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 1:22829 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5227
Mailing Address - Country:US
Mailing Address - Phone:813-949-0464
Mailing Address - Fax:813-948-0027
Practice Address - Street 1:22829 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5227
Practice Address - Country:US
Practice Address - Phone:813-949-0464
Practice Address - Fax:813-948-0027
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist