Provider Demographics
NPI:1407173032
Name:CORSINI, BARRETT KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:KYLE
Last Name:CORSINI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S KALANCHOE AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0988
Mailing Address - Country:US
Mailing Address - Phone:918-859-6932
Mailing Address - Fax:
Practice Address - Street 1:1725 E 19TH ST STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5426
Practice Address - Country:US
Practice Address - Phone:918-742-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist