Provider Demographics
NPI:1437825148
Name:CELOSO, CORINNA MISHAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:MISHAL
Last Name:CELOSO
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 1:400 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3813
Mailing Address - Country:US
Mailing Address - Phone:501-847-4615
Mailing Address - Fax:501-847-7693
Practice Address - Street 1:400 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3813
Practice Address - Country:US
Practice Address - Phone:501-847-4615
Practice Address - Fax:501-847-7693
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist