Provider Demographics
NPI:1215344049
Name:COBB, ASHTON TYQUILAN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:TYQUILAN
Last Name:COBB
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 SLAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4724
Mailing Address - Country:US
Mailing Address - Phone:904-314-0407
Mailing Address - Fax:
Practice Address - Street 1:960 BACKSTAGE LANE
Practice Address - Street 2:
Practice Address - City:LAKE BUENA VISTA
Practice Address - State:FL
Practice Address - Zip Code:32830-8472
Practice Address - Country:US
Practice Address - Phone:407-934-4100
Practice Address - Fax:407-934-4101
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist