Cobra Pharmacy, LLC
NPI 1558762138ActiveOrganization· Pharmacy· Lucasville, OH
Pharmacy in Lucasville, Ohio, registered in NPPES in September 2014. The authorized official on file is Brandon Lee Holbrook, PHARMD, RPH, Member/Pharmacist In Charge. Medicare paid $2,144 for services to 18 patients in 2024.
Overview
| NPI | 1558762138 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 15, 2014 |
| Last updated in NPPES | Apr 27, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 02242120003 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Mass Immunization (Roster Biller Only) (OH) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 18 |
|---|---|
| Services billed | 38 across 7 procedure codes |
| Paid by Medicare | $2,144 |
Other Pharmacy providers in Lucasville
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