Provider Demographics
NPI:1710164991
Name:BRAUEN, KOREY
Entity Type:Individual
Prefix:DR
First Name:KOREY
Middle Name:
Last Name:BRAUEN
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 1:153 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1149
Mailing Address - Country:US
Mailing Address - Phone:585-591-0945
Mailing Address - Fax:585-591-3019
Practice Address - Street 1:153 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1149
Practice Address - Country:US
Practice Address - Phone:585-591-0945
Practice Address - Fax:585-591-3019
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 050976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist