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General NPI Number Information
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NPI Number | 1497810824
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Entity Type | Organization
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Legal Business Name | CORBIN PHARMACY INC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 14 MOONBOW PLZ STE 1
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City | CORBIN
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State | KY
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Zip | 40701-8910
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Country | US
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Telephone | 606-523-5585
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Fax | 606-523-4418
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Provider Business Mailing Address
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Address Line | 14 MOONBOW PLZ STE 1
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City | CORBIN
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State | KY
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Zip | 40701-8910
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Country | US
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Telephone | 606-523-5585
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Fax | 606-523-4418
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN ELLIOT
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Credential | RPH
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Telephone | 606-523-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P06688
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License Number State | KY
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