Provider Demographics
NPI:1053585687
Name:CORBETT PHARMACY INC
Entity type:Organization
Organization Name:CORBETT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-487-4199
Mailing Address - Street 1:145 STATE HIGHWAY 253
Mailing Address - Street 2:STE C
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5364
Mailing Address - Country:US
Mailing Address - Phone:205-487-4199
Mailing Address - Fax:205-932-8095
Practice Address - Street 1:145 STATE HIGHWAY 253
Practice Address - Street 2:STE C
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5364
Practice Address - Country:US
Practice Address - Phone:205-487-4199
Practice Address - Fax:205-487-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1027593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0135295OtherNCPDP PROVIDER IDENTIFICATION NUMBER