Provider Demographics
NPI:1649527680
Name:COHRON, PETER PRUITT (BSPHARM, JD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:PRUITT
Last Name:COHRON
Suffix:
Gender:M
Credentials:BSPHARM, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TARTAN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4775
Mailing Address - Country:US
Mailing Address - Phone:270-212-0937
Mailing Address - Fax:270-212-0937
Practice Address - Street 1:408 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1240
Practice Address - Country:US
Practice Address - Phone:270-389-4559
Practice Address - Fax:270-389-9496
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008337183500000X
IN26091860A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist