Provider Demographics
NPI:1023029873
Name:CORLESS, JEFFREY F (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:F
Last Name:CORLESS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6056 S FASHION SQUARE DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7355
Mailing Address - Country:US
Mailing Address - Phone:801-587-6328
Mailing Address - Fax:801-263-3304
Practice Address - Street 1:6056 S FASHION SQUARE DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7355
Practice Address - Country:US
Practice Address - Phone:801-587-6328
Practice Address - Fax:801-263-3304
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist