MEDICARE: MR. COREY A SORREL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835N0905X	Nuclear Pharmacist	PH16005	LA

General Provider Information

NPI Number	:	1447460951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COREY A SORREL RPH

Provider Business Mailing Address
First Line	:	22829 BEAVER CREEK DRIVE
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791
Country	:	US
Telephone Number	:	225-658-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	7525 PICARDY AVE
Second Line	:	SUITE 120
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4334
Country	:	US
Telephone Number	:	225-768-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. COREY A SORREL RPH” Practice Location

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