Provider Demographics
NPI:1871010553
Name:KORNBLUM, MAGGIE MEADOWS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MEADOWS
Last Name:KORNBLUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:OLIVIA
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:433 ESTHWAITE DR SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-3408
Mailing Address - Country:US
Mailing Address - Phone:252-646-2579
Mailing Address - Fax:
Practice Address - Street 1:1531 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2608
Practice Address - Country:US
Practice Address - Phone:910-457-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist