Provider Demographics
NPI:1619572534
Name:CORBETT, ALEXANDRA C (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:C
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1277 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-4040
Mailing Address - Country:US
Mailing Address - Phone:708-946-3714
Mailing Address - Fax:
Practice Address - Street 1:1277 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-4040
Practice Address - Country:US
Practice Address - Phone:708-946-3714
Practice Address - Fax:708-946-3774
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty