Provider Demographics
NPI:1912583691
Name:COX, PATRICK BRYAN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BRYAN
Last Name:COX
Suffix:SR
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 1:264 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:TN
Mailing Address - Zip Code:37645-3317
Mailing Address - Country:US
Mailing Address - Phone:423-470-2730
Mailing Address - Fax:
Practice Address - Street 1:264 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MT CARMEL
Practice Address - State:TN
Practice Address - Zip Code:37645-3317
Practice Address - Country:US
Practice Address - Phone:423-470-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN006167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN006167OtherSTATE OF TENNESSEE