Provider Demographics
NPI:1447460951
Name:SORREL, COREY A (RPH)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:A
Last Name:SORREL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22829 BEAVER CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-658-7829
Mailing Address - Fax:
Practice Address - Street 1:7525 PICARDY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4334
Practice Address - Country:US
Practice Address - Phone:225-768-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPH160051835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear