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General NPI Number Information
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NPI Number | 1164050944
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Entity Type | Organization
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Legal Business Name | CORRIDOR PHARMACY
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 03/29/2020
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Provider Practice Location Address
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Address Line | 650 W CHERRY ST STE 7
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-9025
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Country | US
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Telephone | 319-331-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 SILVER MAPLE TRL
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-4738
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Country | US
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Telephone | 319-331-9005
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MRS. KYRA CORBETT
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Credential | PHARMD
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Telephone | 319-331-9005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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