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General NPI Number Information
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NPI Number | 1417131665
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Entity Type | Individual
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Provider Name | CORI K VANDEVENDER PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 523 4TH AVE SE
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City | RED BAY
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State | AL
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Zip | 35582
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Country | US
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Telephone | 256-356-9204
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Fax |
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Provider Business Mailing Address
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Address Line | 27040 US HIGHWAY 98
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City | DAPHNE
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State | AL
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Zip | 36526-4824
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Country | US
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Telephone | 516-259-0962
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Fax | 251-621-5754
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15255
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License Number State | AL
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