Provider Demographics
NPI:1285236752
Name:CORVIN, ROBIN KIM
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:KIM
Last Name:CORVIN
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 1:109 W CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8703
Mailing Address - Country:US
Mailing Address - Phone:405-410-5452
Mailing Address - Fax:405-684-9751
Practice Address - Street 1:1500 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7214
Practice Address - Country:US
Practice Address - Phone:405-684-9764
Practice Address - Fax:405-684-9751
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist