Provider Demographics
NPI:1922431584
Name:PONTIER, COREY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:M
Last Name:PONTIER
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 1:4201 HOLMES ST
Mailing Address - Street 2:APT 3
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1139
Mailing Address - Country:US
Mailing Address - Phone:304-544-5238
Mailing Address - Fax:
Practice Address - Street 1:4201 HOLMES ST
Practice Address - Street 2:APT 3
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1139
Practice Address - Country:US
Practice Address - Phone:304-544-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-17
Last Update Date:2013-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist