Provider Demographics
NPI:1811015365
Name:CORCORAN, KELLY J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0166
Mailing Address - Country:US
Mailing Address - Phone:804-556-3607
Mailing Address - Fax:804-556-2414
Practice Address - Street 1:1956 SANDY HOOK RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3107
Practice Address - Country:US
Practice Address - Phone:804-556-3607
Practice Address - Fax:804-556-3607
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist