Provider Demographics
NPI:1841885175
Name:COBB, MARION BROWN (RPH)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:BROWN
Last Name:COBB
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 1:1224 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:KEMP
Mailing Address - State:TX
Mailing Address - Zip Code:75143-7708
Mailing Address - Country:US
Mailing Address - Phone:214-693-5055
Mailing Address - Fax:
Practice Address - Street 1:1224 S ELM ST
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-7708
Practice Address - Country:US
Practice Address - Phone:903-498-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXXXXXXXXXXXMedicaid