Healthcare Provider Details

I. General information

NPI: 1922644400
Provider Name (Legal Business Name): AMBER CORSBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 N CLINTON ST
FORT WAYNE IN
46805-1230
US

IV. Provider business mailing address

4120 N CLINTON ST
FORT WAYNE IN
46805-1230
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-3185
  • Fax:
Mailing address:
  • Phone: 260-483-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028359A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26028359A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: