Healthcare Provider Details

I. General information

NPI: 1952775587
Provider Name (Legal Business Name): MICHELLE CORSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 CHURCH ST
CONWAY SC
29526-4824
US

IV. Provider business mailing address

418 STARLIT WAY
MYRTLE BEACH SC
29579-4375
US

V. Phone/Fax

Practice location:
  • Phone: 347-701-7242
  • Fax:
Mailing address:
  • Phone: 347-701-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061022
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60562
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: