Provider Demographics
NPI:1396764213
Name:CORLEY & MCCLENDON, INC.
Entity type:Organization
Organization Name:CORLEY & MCCLENDON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-884-2661
Mailing Address - Street 1:18 NEW AIRPORT ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-885-9213
Mailing Address - Fax:706-885-9829
Practice Address - Street 1:18 NEW AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-884-2517
Practice Address - Fax:706-882-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0070193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00383666AMedicaid
GAPHRE007019OtherSTATE PHARMACY LICENSE
1133393OtherNCPDP#
GA000383666AMedicaid
1396764213OtherNPI
1396764213OtherNPI
1133393OtherNCPDP#