Provider Demographics
NPI:1538419080
Name:CORLEY, JAMES SELF III
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SELF
Last Name:CORLEY
Suffix:III
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 1:1302 HWY 72-221 EAST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-223-1891
Mailing Address - Fax:864-223-4144
Practice Address - Street 1:1302 HWY 72-221 EAST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-223-1891
Practice Address - Fax:864-223-4144
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist