Provider Demographics
NPI:1871870220
Name:KORBY, STEPHANIE A (PHARMD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:KORBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-6878
Mailing Address - Country:US
Mailing Address - Phone:763-078-9179
Mailing Address - Fax:
Practice Address - Street 1:501 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5341
Practice Address - Country:US
Practice Address - Phone:630-789-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist