Provider Demographics
NPI:1932498300
Name:DEWEY, KORALIA (RPH)
Entity Type:Individual
Prefix:
First Name:KORALIA
Middle Name:
Last Name:DEWEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 FAIRLEE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3505
Mailing Address - Country:US
Mailing Address - Phone:302-529-7471
Mailing Address - Fax:
Practice Address - Street 1:2713 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2523
Practice Address - Country:US
Practice Address - Phone:302-798-9520
Practice Address - Fax:302-798-6610
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002368183500000X
PARP034280L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist