Provider Demographics
NPI:1780692442
Name:COHEN, EDWARD S
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6859
Mailing Address - Country:US
Mailing Address - Phone:847-964-6296
Mailing Address - Fax:847-964-6767
Practice Address - Street 1:1415 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5213
Practice Address - Country:US
Practice Address - Phone:847-964-6296
Practice Address - Fax:847-964-6767
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist