Provider Demographics
NPI:1831791904
Name:COBOS, MARA LISA (RPH)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LISA
Last Name:COBOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 FRIO ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8376
Mailing Address - Country:US
Mailing Address - Phone:956-588-5018
Mailing Address - Fax:
Practice Address - Street 1:1301 W SAM HOUSTON BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5669
Practice Address - Country:US
Practice Address - Phone:956-782-1156
Practice Address - Fax:956-782-2115
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist