MEDICARE: MRS. BRENDA H CORBETT RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03314233	OH

General Provider Information

NPI Number	:	1003059163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA H CORBETT RPH

Provider Business Mailing Address
First Line	:	8025 GREEN LAKE DR
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9475
Country	:	US
Telephone Number	:	513-295-2175
Fax Number	:	513-755-9290

Provider Business Practice Location Address
First Line	:	898 S MAIN ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-3439
Country	:	US
Telephone Number	:	937-433-4909
Fax Number	:	937-474-9972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2009
Last Update Date	:	04/19/2009

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