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MARK CORUM
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1669865440
Individual Registrant: MARK CORUM
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1212 STATE ST WHITE PINE, TN 37890-3467 US
Tel: 865-674-7517 Fax: --
Tel: 865-674-7517 Fax: --
Contact information for business:
868 SELLERS RD JEFFERSON CITY, TN 37760-4203 US
Tel: 865-591-6942 Fax: --
Tel: 865-591-6942 Fax: --
Registration Information:
NPI: 1669865440
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | TN | 9174 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
