Provider Demographics
NPI:1972946176
Name:CORUM, CHAD (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CORUM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 S HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-7514
Mailing Address - Country:US
Mailing Address - Phone:606-599-0505
Mailing Address - Fax:
Practice Address - Street 1:1668 S HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-7514
Practice Address - Country:US
Practice Address - Phone:606-599-0505
Practice Address - Fax:606-599-0508
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist