Provider Demographics
NPI:1740339282
Name:KOBETZ, JEFFREY (RPH,CPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:KOBETZ
Suffix:
Gender:M
Credentials:RPH,CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3458
Mailing Address - Country:US
Mailing Address - Phone:954-439-4884
Mailing Address - Fax:954-431-4665
Practice Address - Street 1:20200 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3458
Practice Address - Country:US
Practice Address - Phone:954-439-4884
Practice Address - Fax:954-431-4665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist