Provider Demographics
NPI:1023152360
Name:COBB, BOBBIE-JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE-JEAN
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 JAMES BERRY RD
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-5251
Mailing Address - Country:US
Mailing Address - Phone:334-391-3942
Mailing Address - Fax:
Practice Address - Street 1:3925 HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-4981
Practice Address - Country:US
Practice Address - Phone:985-549-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist