Provider Demographics
NPI:1003172339
Name:CORGAN, JOSEPH SEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SEAN
Last Name:CORGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 CORGAN RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8206
Mailing Address - Country:US
Mailing Address - Phone:386-736-9745
Mailing Address - Fax:386-446-5851
Practice Address - Street 1:6 FLORIDA PARK DR N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3890
Practice Address - Country:US
Practice Address - Phone:386-445-1212
Practice Address - Fax:386-446-5851
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist