Provider Demographics
NPI:1043936305
Name:HALES, COREY
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HALES
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 1:772 MAGRATH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-2420
Mailing Address - Country:US
Mailing Address - Phone:702-533-8865
Mailing Address - Fax:
Practice Address - Street 1:2910 BICENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-4477
Practice Address - Country:US
Practice Address - Phone:702-567-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist