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General NPI Number Information
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NPI Number | 1174463897
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Entity Type | Individual
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Provider Name | BLAKE GREGORY CORBIN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 1301 N US HIGHWAY 31
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City | PETOSKEY
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State | MI
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Zip | 49770-9317
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Country | US
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Telephone | 231-348-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 1432 STANDISH AVE APT 308E
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City | PETOSKEY
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State | MI
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Zip | 49770-3075
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Country | US
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Telephone |
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Fax |
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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 | 5302417955
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License Number State | MI
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