Healthcare Provider Details

I. General information

NPI: 1164738563
Provider Name (Legal Business Name): JANET CORRELL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 TAMARACK AVE
CARLSBAD CA
92008-3414
US

IV. Provider business mailing address

PO BOX 2082
CARLSBAD CA
92018-2082
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-4877
  • Fax: 760-729-7696
Mailing address:
  • Phone: 760-729-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: