Provider Demographics
NPI:1386994119
Name:CORBETT, JEFFREY PHILLIP (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:CORBETT
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 1:4855 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5024
Mailing Address - Country:US
Mailing Address - Phone:937-279-0468
Mailing Address - Fax:937-279-2262
Practice Address - Street 1:4855 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-5024
Practice Address - Country:US
Practice Address - Phone:937-279-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist