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General NPI Number Information
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NPI Number | 1003172339
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Entity Type | Individual
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Provider Name | JOSEPH SEAN CORGAN RPH
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Gender | Male
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 6 FLORIDA PARK DR N
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City | PALM COAST
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State | FL
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Zip | 32137-3890
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Country | US
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Telephone | 386-445-1212
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Fax | 386-446-5851
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Provider Business Mailing Address
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Address Line | 3735 CORGAN RD
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City | DELAND
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State | FL
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Zip | 32724-8206
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Country | US
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Telephone | 386-736-9745
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Fax | 386-446-5851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS0018261
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License Number State | FL
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