Provider Demographics
NPI:1922403070
Name:COHEN, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 SUTTON LOOP
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5135
Mailing Address - Country:US
Mailing Address - Phone:510-299-6289
Mailing Address - Fax:510-794-6784
Practice Address - Street 1:3393 SUTTON LOOP
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5135
Practice Address - Country:US
Practice Address - Phone:510-299-6289
Practice Address - Fax:510-794-6784
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist