Provider Demographics
NPI:1053904037
Name:CORKERY, ETHAN MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:MICHAEL
Last Name:CORKERY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-7792
Mailing Address - Country:US
Mailing Address - Phone:308-532-0310
Mailing Address - Fax:308-532-2781
Practice Address - Street 1:211 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-7792
Practice Address - Country:US
Practice Address - Phone:308-532-0310
Practice Address - Fax:308-532-2781
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist