Provider Demographics
NPI:1750981155
Name:COGBILL, SUZANNE (PD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:COGBILL
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ALBERT PIKE RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4020
Mailing Address - Country:US
Mailing Address - Phone:501-624-0142
Mailing Address - Fax:501-624-4012
Practice Address - Street 1:1601 ALBERT PIKE RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4020
Practice Address - Country:US
Practice Address - Phone:501-624-0142
Practice Address - Fax:501-624-4012
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist