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General NPI Number Information
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NPI Number | 1619508405
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Entity Type | Individual
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Provider Name | CONSTANCE CORBAT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 26220 CROCKER BLVD
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-2455
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Country | US
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Telephone | 586-954-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 51532 HUNTLEY AVE
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City | NEW BALTIMORE
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State | MI
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Zip | 48047-6505
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Country | US
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Telephone | 586-557-8656
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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 | 5302030377
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License Number State | MI
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