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General NPI Number Information
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NPI Number | 1396262283
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Entity Type | Individual
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Provider Name | JACOB WAYDE CORLEW PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL PENSACOLA 6000 US 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0001
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Country | US
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Telephone | 850-505-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 14423 COUNTY ROAD 626
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City | DEXTER
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State | MO
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Zip | 63841-8795
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Country | US
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Telephone | 573-614-9296
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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 | 2006025347
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License Number State | MO
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