Provider Demographics
NPI:1992338693
Name:BRIGGS, CORY
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:BRIGGS
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 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1751
Mailing Address - Country:US
Mailing Address - Phone:920-687-6193
Mailing Address - Fax:
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-1751
Practice Address - Country:US
Practice Address - Phone:920-687-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20048-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist