Provider Demographics
NPI:1427272707
Name:COBB PHARMACY
Entity type:Organization
Organization Name:COBB PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:361-449-2631
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:510 HOUSTON ST
Mailing Address - City:GEORGE WEST
Mailing Address - State:TX
Mailing Address - Zip Code:78022
Mailing Address - Country:US
Mailing Address - Phone:361-449-2631
Mailing Address - Fax:361-449-2905
Practice Address - Street 1:510 HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:GEORGE WEST
Practice Address - State:TX
Practice Address - Zip Code:78022
Practice Address - Country:US
Practice Address - Phone:361-449-2631
Practice Address - Fax:361-449-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11077305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service