Healthcare Provider Details

I. General information

NPI: 1750636098
Provider Name (Legal Business Name): LAUREN KORBA PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 09/17/2021
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BUTTERMILK PIKE
CRESCENT SPRINGS KY
41017-1302
US

IV. Provider business mailing address

8 MIAMI DR
FORT MITCHELL KY
41017-2853
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-1824
  • Fax:
Mailing address:
  • Phone: 859-322-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03132195
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: