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General NPI Number Information
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NPI Number | 1649854829
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Entity Type | Individual
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Provider Name | COREY FETE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 600 ACKERMAN RD # E1014
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City | COLUMBUS
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State | OH
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Zip | 43202-4500
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Country | US
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Telephone | 614-685-1672
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W GOODALE ST APT 244
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City | COLUMBUS
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State | OH
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Zip | 43215-1904
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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 | 03237177
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License Number State | OH
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