Provider Demographics
NPI:1629670807
Name:CORBETT, TRINA TOPSHE
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:TOPSHE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148-9168
Mailing Address - Country:US
Mailing Address - Phone:803-485-2555
Mailing Address - Fax:803-485-4306
Practice Address - Street 1:115B MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-6904
Practice Address - Country:US
Practice Address - Phone:803-485-2555
Practice Address - Fax:803-485-4306
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist