Provider Demographics
NPI:1639494164
Name:CORBO, VITA GIOVANNA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VITA
Middle Name:GIOVANNA
Last Name:CORBO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1914
Mailing Address - Country:US
Mailing Address - Phone:718-767-6604
Mailing Address - Fax:
Practice Address - Street 1:25121 JAMAICA
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2218
Practice Address - Country:US
Practice Address - Phone:516-488-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist