Provider Demographics
NPI:1295913275
Name:COHEN, TED ELLIOT (RPH)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:ELLIOT
Last Name:COHEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 CHAMBERS ST. EAST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974
Mailing Address - Country:US
Mailing Address - Phone:239-770-6798
Mailing Address - Fax:
Practice Address - Street 1:645 CHAMBERS ST. EAST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974
Practice Address - Country:US
Practice Address - Phone:239-770-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029124183500000X
FLPS49621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist