Provider Demographics
NPI:1366620551
Name:COHN, SAMUEL WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WILLIAM
Last Name:COHN
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 1:15 RANGER LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-3039
Mailing Address - Country:US
Mailing Address - Phone:860-586-8353
Mailing Address - Fax:
Practice Address - Street 1:772 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2407
Practice Address - Country:US
Practice Address - Phone:860-232-5964
Practice Address - Fax:860-232-5984
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6261183500000X
MA20876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist