Provider Demographics
NPI:1952793267
Name:KOBELIN, LEIGH (R PH C PH)
Entity Type:Individual
Prefix:MR
First Name:LEIGH
Middle Name:
Last Name:KOBELIN
Suffix:
Gender:M
Credentials:R PH C PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FLAGLER PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-5967
Mailing Address - Country:US
Mailing Address - Phone:386-517-0010
Mailing Address - Fax:386-439-6850
Practice Address - Street 1:111 FLAGLER PLAZA DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-5967
Practice Address - Country:US
Practice Address - Phone:386-517-0010
Practice Address - Fax:386-439-6850
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist