Healthcare Provider Details

I. General information

NPI: 1811814437
Provider Name (Legal Business Name): STEPHANIE MALLOW CORBETT PHARMD, MBA, FCCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 PEN PARK LN
CHARLOTTESVILLE VA
22901-3777
US

IV. Provider business mailing address

1323 PEN PARK LN
CHARLOTTESVILLE VA
22901-3777
US

V. Phone/Fax

Practice location:
  • Phone: 434-906-8792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number033.0003560
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202208716
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: