Provider Demographics
NPI:1538101167
Name:CORKREANS THE PHARMACIST INC
Entity Type:Organization
Organization Name:CORKREANS THE PHARMACIST INC
Other - Org Name:THE PHARMACIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CORKREAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-742-8080
Mailing Address - Street 1:32713 COUNTY ROAD 473
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-8856
Mailing Address - Country:US
Mailing Address - Phone:352-742-8080
Mailing Address - Fax:352-742-9292
Practice Address - Street 1:32713 COUNTY ROAD 473
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8856
Practice Address - Country:US
Practice Address - Phone:352-742-8080
Practice Address - Fax:352-742-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101248700Medicaid
FL101248701Medicaid
FL1067277OtherNABP
FL1067277OtherNABP
FL0511850001Medicare ID - Type UnspecifiedMEDICARE
FL0511850001Medicare NSC