Provider Demographics
NPI:1366988271
Name:KALINOWSKI, COREY BRAEDEN
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:BRAEDEN
Last Name:KALINOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4426
Mailing Address - Country:US
Mailing Address - Phone:716-807-8456
Mailing Address - Fax:
Practice Address - Street 1:301 OAKBROOK LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7539
Practice Address - Country:US
Practice Address - Phone:843-832-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist