Provider Demographics
NPI:1184960155
Name:CORKILL, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CORKILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 N POWER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3705
Mailing Address - Country:US
Mailing Address - Phone:480-281-2990
Mailing Address - Fax:
Practice Address - Street 1:1855 N POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3705
Practice Address - Country:US
Practice Address - Phone:480-281-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011234183500000X
MI5302025849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist