Provider Demographics
NPI:1649677741
Name:COBB, BRIAN EUGENE (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EUGENE
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 1:1906 VISTA DEL LAGO DR
Mailing Address - Street 2:SUITE G.
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-9700
Mailing Address - Country:US
Mailing Address - Phone:209-980-3299
Mailing Address - Fax:209-920-3391
Practice Address - Street 1:1906 VISTA DEL LAGO DR
Practice Address - Street 2:SUITE G.
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9700
Practice Address - Country:US
Practice Address - Phone:209-980-3299
Practice Address - Fax:209-920-3391
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist