Provider Demographics
NPI:1649486762
Name:COBB, MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7279 PARSONAGE RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:MI
Mailing Address - Zip Code:48881-9514
Mailing Address - Country:US
Mailing Address - Phone:616-642-9428
Mailing Address - Fax:
Practice Address - Street 1:632 N DIBBLE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2830
Practice Address - Country:US
Practice Address - Phone:517-323-2382
Practice Address - Fax:517-323-0459
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist