Healthcare Provider Details

I. General information

NPI: 1154635233
Provider Name (Legal Business Name): SHANNON MAURA CORKREAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 SE 17TH ST
OCALA FL
34471-4428
US

IV. Provider business mailing address

9530 MID SUMMER LN
LEESBURG FL
34788-3698
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-3666
  • Fax:
Mailing address:
  • Phone: 352-409-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: