Provider Demographics
NPI:1639351521
Name:RACE, CORINNE LEIGH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:LEIGH
Last Name:RACE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 NUTHATCH CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5523
Mailing Address - Country:US
Mailing Address - Phone:516-662-0009
Mailing Address - Fax:
Practice Address - Street 1:2907 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8491
Practice Address - Country:US
Practice Address - Phone:803-548-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist