Provider Demographics
NPI:1184885824
Name:CORBET-OWEN, PETER DAVID (RPH CALIFORNIA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DAVID
Last Name:CORBET-OWEN
Suffix:
Gender:M
Credentials:RPH CALIFORNIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 MARSH CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3034
Mailing Address - Country:US
Mailing Address - Phone:707-227-6191
Mailing Address - Fax:
Practice Address - Street 1:2055 SOLANO AVE
Practice Address - Street 2:SOLANO SHOPPING CENTER
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:707-552-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist