Provider Demographics
NPI:1174145163
Name:CORBETT, KILEY ANN
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:ANN
Last Name:CORBETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:ANN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 FARRINGTON HWY UNIT 300
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2002
Mailing Address - Country:US
Mailing Address - Phone:808-674-0269
Mailing Address - Fax:808-674-0955
Practice Address - Street 1:590 FARRINGTON HWY UNIT 300
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2002
Practice Address - Country:US
Practice Address - Phone:808-674-0269
Practice Address - Fax:808-674-0955
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist