Provider Demographics
NPI:1366487886
Name:CORLEY'S PHARMACY INC
Entity Type:Organization
Organization Name:CORLEY'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-638-7552
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37744-0874
Mailing Address - Country:US
Mailing Address - Phone:423-638-7552
Mailing Address - Fax:423-638-2552
Practice Address - Street 1:1004 SNAPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4029
Practice Address - Country:US
Practice Address - Phone:423-638-7552
Practice Address - Fax:423-638-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452424Medicaid
4415041OtherNCPDP
TN1452424Medicaid