Provider Demographics
NPI:1427334044
Name:COBB, SHAYNA WALTERS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:WALTERS
Last Name:COBB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 YULEE CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1138
Mailing Address - Country:US
Mailing Address - Phone:757-722-0795
Mailing Address - Fax:757-722-1524
Practice Address - Street 1:235 E MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2458
Practice Address - Country:US
Practice Address - Phone:757-722-0795
Practice Address - Fax:757-722-1524
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202267592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202267592OtherVA- BOARD OF PHARMACT LICENSE