Individual provider Active NPI

Wayne L Cohen, RPH

  • Pharmacist
  • Lake Havasu City, AZ
National Provider Identifier
1346568409
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
S015278 Issued in AZ
Practice address
25 Lake Havasu Ave S
Lake Havasu City, AZ 86403-6565
Phone
(928) 453-2808
Fax
(928) 453-2619
NPI assigned
May 12, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X S015278 AZ Primary

Addresses

Primary practice location

25 Lake Havasu Ave S
Lake Havasu City, AZ 86403-6565

Mailing address

1800 Burgundy Dr
Lake Havasu City, AZ 86404-1050
Phone (928) 453-8795

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
S015278AZMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273622400000",
    "number": "1346568409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 BURGUNDY DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864041050",
            "telephone_number": "928-453-8795",
            "fax_number": "928-453-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 LAKE HAVASU AVE S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036565",
            "telephone_number": "928-453-2808",
            "fax_number": "928-453-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COHEN",
        "first_name": "WAYNE",
        "middle_name": "L",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-12",
        "last_updated": "2010-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S015278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.