Healthcare Provider Details

I. General information

NPI: 1720631740
Provider Name (Legal Business Name): COREY CHRISTOPHER BURRELLI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE MATHER B400
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-983-4747
  • Fax:
Mailing address:
  • Phone: 216-983-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03135865
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: