Healthcare Provider Details

I. General information

NPI: 1396202032
Provider Name (Legal Business Name): COREY LYNN FINNELL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 WHITE BLOSSOM CIR
SAINT CLOUD FL
34771-9231
US

IV. Provider business mailing address

5305 WHITE BLOSSOM CIR
SAINT CLOUD FL
34771-9231
US

V. Phone/Fax

Practice location:
  • Phone: 770-362-2351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0206X
TaxonomyCardiology Pharmacist
License NumberPS57870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57870
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPS57870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: