Provider Demographics
NPI:1053907253
Name:COHEN SEDGH, ROBERT (20SY-M04I-RBHH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:COHEN SEDGH
Suffix:
Gender:M
Credentials:20SY-M04I-RBHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 NEWCASTLE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2033
Mailing Address - Country:US
Mailing Address - Phone:818-314-1413
Mailing Address - Fax:
Practice Address - Street 1:5403 NEWCASTLE AVE APT 5
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2033
Practice Address - Country:US
Practice Address - Phone:818-314-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist