Provider Demographics
NPI:1467739797
Name:CORICA, CHRIS L (RPH)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:L
Last Name:CORICA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2055
Mailing Address - Country:US
Mailing Address - Phone:414-464-4601
Mailing Address - Fax:414-464-5438
Practice Address - Street 1:7600 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2055
Practice Address - Country:US
Practice Address - Phone:414-464-4601
Practice Address - Fax:414-464-5438
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12291-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist