Provider Demographics
NPI:1588651251
Name:MINNICH, CORY D (RPH)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:D
Last Name:MINNICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SAYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8778
Mailing Address - Country:US
Mailing Address - Phone:717-626-4298
Mailing Address - Fax:
Practice Address - Street 1:1021 SHARP AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1135
Practice Address - Country:US
Practice Address - Phone:717-733-1215
Practice Address - Fax:717-733-9109
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-035414L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist