Provider Demographics
NPI:1891147872
Name:CORLEW, PHILLIP W (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:W
Last Name:CORLEW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-0433
Mailing Address - Country:US
Mailing Address - Phone:706-399-1780
Mailing Address - Fax:
Practice Address - Street 1:2751 BEAVER RUN BLVD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-5381
Practice Address - Country:US
Practice Address - Phone:843-215-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11520183500000X
GARPH023144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist