Provider Demographics
NPI:1699086348
Name:KORF, SUSAN AVERRIE (BS PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:AVERRIE
Last Name:KORF
Suffix:
Gender:F
Credentials:BS PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-4900
Mailing Address - Country:US
Mailing Address - Phone:925-998-7824
Mailing Address - Fax:423-317-8302
Practice Address - Street 1:1959 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3777
Practice Address - Country:US
Practice Address - Phone:423-317-7303
Practice Address - Fax:423-317-8302
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015859183500000X
TN130730183500000X
NC7807183500000X
HI2526183500000X
CA46889183500000X
WA00069571183500000X
OR7131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist