Provider Demographics
NPI:1922603786
Name:COBO, MARK ANDREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:COBO
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 1:176 BRADWELL RD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5831
Mailing Address - Country:US
Mailing Address - Phone:630-363-4590
Mailing Address - Fax:
Practice Address - Street 1:20 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4384
Practice Address - Country:US
Practice Address - Phone:847-459-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist