Provider Demographics
NPI:1598042020
Name:CORELLA, PASQUALE JOSEPH (R PH)
Entity Type:Individual
Prefix:MR
First Name:PASQUALE
Middle Name:JOSEPH
Last Name:CORELLA
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6552
Mailing Address - Country:US
Mailing Address - Phone:305-292-2979
Mailing Address - Fax:
Practice Address - Street 1:527 DUVAL ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6552
Practice Address - Country:US
Practice Address - Phone:305-292-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist