Provider Demographics
NPI:1821673047
Name:CORRADETTI, JEFFREY (CPHT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CORRADETTI
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 SAINT IVES RD UNIT 1123
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-1168
Mailing Address - Country:US
Mailing Address - Phone:302-388-4956
Mailing Address - Fax:
Practice Address - Street 1:3411 SOCASTEE BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6111
Practice Address - Country:US
Practice Address - Phone:843-294-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32906183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician