Provider Demographics
NPI:1700497674
Name:CORRIGAN, CALEB RAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:RAY
Last Name:CORRIGAN
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 1:300 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2307
Mailing Address - Country:US
Mailing Address - Phone:309-837-2436
Mailing Address - Fax:309-837-9024
Practice Address - Street 1:300 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2307
Practice Address - Country:US
Practice Address - Phone:309-837-2436
Practice Address - Fax:309-837-9024
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist