Provider Demographics
NPI:1285040204
Name:CORLEW, LINDSEY BALLARD (PHARM D)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BALLARD
Last Name:CORLEW
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HUNTER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2248
Mailing Address - Country:US
Mailing Address - Phone:573-472-0608
Mailing Address - Fax:573-472-1814
Practice Address - Street 1:808 HUNTER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2248
Practice Address - Country:US
Practice Address - Phone:573-472-0608
Practice Address - Fax:573-472-1814
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023337183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy