Provider Demographics
NPI:1679859672
Name:COREY, JERALYN
Entity type:Individual
Prefix:
First Name:JERALYN
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 S HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7624
Mailing Address - Country:US
Mailing Address - Phone:843-357-4300
Mailing Address - Fax:843-357-2480
Practice Address - Street 1:2939 S HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7624
Practice Address - Country:US
Practice Address - Phone:843-357-4300
Practice Address - Fax:843-357-2480
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2601322A183500000X
SC7601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist