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NPI Code Detail

MEDICARE: DR. EDWARD KOROBKOV PHARMD

MEDICARE: DR. EDWARD KOROBKOV PHARMD
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
1183500000XPharmacistPCT.0014589CT

General Provider Information

NPI Number : 1013491877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD KOROBKOV PHARMD
Provider Business Mailing Address
First Line : 20 BELMONT ST
Second Line :
City : WESTFIELD
State : MA
Zip : 01085-2324
Country : US
Telephone Number : 413-875-5680
Fax Number :
Provider Business Practice Location Address
First Line : 479 BLUE HILLS AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06112-1514
Country : US
Telephone Number : 860-769-6870
Fax Number : 860-769-6876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2018
Last Update Date : 07/18/2023

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