Provider Demographics
NPI:1639509839
Name:CORBIN, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CORBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 W BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-2880
Mailing Address - Country:US
Mailing Address - Phone:479-846-6901
Mailing Address - Fax:479-846-6903
Practice Address - Street 1:881 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-2880
Practice Address - Country:US
Practice Address - Phone:479-846-6901
Practice Address - Fax:479-846-6903
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist