Provider Demographics
NPI:1598781916
Name:PAGE, CORY W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:W
Last Name:PAGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 GREENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3328
Mailing Address - Country:US
Mailing Address - Phone:801-465-4182
Mailing Address - Fax:
Practice Address - Street 1:652 N 800 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1651
Practice Address - Country:US
Practice Address - Phone:801-798-9788
Practice Address - Fax:801-798-2533
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist