Provider Demographics
NPI:1124846712
Name:COTTON, EBONY (PHARMD)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 RICHSMITH LN APT 204
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9241
Mailing Address - Country:US
Mailing Address - Phone:870-575-2462
Mailing Address - Fax:
Practice Address - Street 1:3001 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3207
Practice Address - Country:US
Practice Address - Phone:870-575-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist