Provider Demographics
NPI:1194320317
Name:PISK, COREY (PHARMD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:PISK
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 1:5800 AMERICAN BLVD W APT 452
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1486
Mailing Address - Country:US
Mailing Address - Phone:763-438-8921
Mailing Address - Fax:
Practice Address - Street 1:8150 WEDGEWOOD LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-9400
Practice Address - Country:US
Practice Address - Phone:763-494-8355
Practice Address - Fax:763-494-8358
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist