Provider Demographics
NPI:1962044537
Name:CORSEY, TONI MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MARIE
Last Name:CORSEY
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 1:4257 W SPRUCE LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7144
Mailing Address - Country:US
Mailing Address - Phone:801-803-2303
Mailing Address - Fax:
Practice Address - Street 1:4080 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8928
Practice Address - Country:US
Practice Address - Phone:801-280-5545
Practice Address - Fax:801-280-5324
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371854-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4608747Medicaid