Provider Demographics
NPI:1366696205
Name:KORBUL, TEARE (RPH)
Entity type:Individual
Prefix:
First Name:TEARE
Middle Name:
Last Name:KORBUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TEARE
Other - Middle Name:
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:GRAND GORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12434-0089
Mailing Address - Country:US
Mailing Address - Phone:607-588-7429
Mailing Address - Fax:607-588-7429
Practice Address - Street 1:60595 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GRAND GORGE
Practice Address - State:NY
Practice Address - Zip Code:12434
Practice Address - Country:US
Practice Address - Phone:607-588-7429
Practice Address - Fax:607-588-7429
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist