Provider Demographics
NPI:1386939080
Name:ENGSTROM, COREY CRAIG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:CRAIG
Last Name:ENGSTROM
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 1:815 S REES ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8876
Mailing Address - Country:US
Mailing Address - Phone:425-256-1521
Mailing Address - Fax:
Practice Address - Street 1:500 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1812
Practice Address - Country:US
Practice Address - Phone:509-765-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60145821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist