Provider Demographics
NPI:1154613057
Name:COHN, THEODORE
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:COHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23132 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1443
Mailing Address - Country:US
Mailing Address - Phone:216-291-2163
Mailing Address - Fax:
Practice Address - Street 1:13470 CEDAR RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2636
Practice Address - Country:US
Practice Address - Phone:216-371-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03307221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist