Healthcare Provider Details

I. General information

NPI: 1205534799
Provider Name (Legal Business Name): TONYA C CORBETT PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 YOUNG PINE RD
ORLANDO FL
32829-7400
US

IV. Provider business mailing address

1144 CASTLE WOOD TER APT 200
CASSELBERRY FL
32707-3687
US

V. Phone/Fax

Practice location:
  • Phone: 847-315-2500
  • Fax:
Mailing address:
  • Phone: 407-271-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number104346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: