Provider Demographics
NPI:1497810824
Name:CORBIN PHARMACY INC
Entity Type:Organization
Organization Name:CORBIN PHARMACY INC
Other - Org Name:CORBIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-523-5585
Mailing Address - Street 1:14 MOONBOW PLZ
Mailing Address - Street 2:STE 1
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8910
Mailing Address - Country:US
Mailing Address - Phone:606-523-5585
Mailing Address - Fax:606-523-4418
Practice Address - Street 1:14 MOONBOW PLZ
Practice Address - Street 2:STE 1
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8910
Practice Address - Country:US
Practice Address - Phone:606-523-5585
Practice Address - Fax:606-523-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP066883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54002605Medicaid
1827053OtherNCPDP PROVIDER IDENTIFICATION NUMBER