Provider Demographics
NPI:1336636992
Name:CORDER, LORELEI B (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:B
Last Name:CORDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N KING RD
Mailing Address - Street 2:
Mailing Address - City:FLINTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37335-5321
Mailing Address - Country:US
Mailing Address - Phone:931-993-9246
Mailing Address - Fax:
Practice Address - Street 1:1224 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3618
Practice Address - Country:US
Practice Address - Phone:931-433-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11748OtherSTATE LICENSE