Provider Demographics
NPI:1881956662
Name:CORBETT'S PHARMACY LLC
Entity type:Organization
Organization Name:CORBETT'S PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-932-7455
Mailing Address - Street 1:1716 TEMPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1309
Mailing Address - Country:US
Mailing Address - Phone:205-932-7455
Mailing Address - Fax:205-932-3040
Practice Address - Street 1:1716 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1309
Practice Address - Country:US
Practice Address - Phone:205-932-7455
Practice Address - Fax:205-932-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1139183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137960OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL6760910001Medicare NSC