Provider Demographics
NPI:1912257411
Name:CORN, PAUL HIX
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HIX
Last Name:CORN
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 1:1300 TIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1114
Mailing Address - Country:US
Mailing Address - Phone:864-653-6724
Mailing Address - Fax:864-653-4736
Practice Address - Street 1:1300 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1114
Practice Address - Country:US
Practice Address - Phone:864-654-6724
Practice Address - Fax:864-653-4736
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist