Provider Demographics
NPI:1013491877
Name:KOROBKOV, EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:KOROBKOV
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 1:20 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-2324
Mailing Address - Country:US
Mailing Address - Phone:413-875-5680
Mailing Address - Fax:
Practice Address - Street 1:479 BLUE HILLS AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1514
Practice Address - Country:US
Practice Address - Phone:860-769-6870
Practice Address - Fax:860-769-6876
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist