Healthcare Provider Details

I. General information

NPI: 1003059163
Provider Name (Legal Business Name): BRENDA H CORBETT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2009
Last Update Date: 04/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 S MAIN ST
CENTERVILLE OH
45458-3439
US

IV. Provider business mailing address

8025 GREEN LAKE DR
LIBERTY TOWNSHIP OH
45044-9475
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-4909
  • Fax: 937-474-9972
Mailing address:
  • Phone: 513-295-2175
  • Fax: 513-755-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03314233
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: