MEDICARE: JOSEPH M CORAK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	146862-1701	UT

General Provider Information

NPI Number	:	1922272681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M CORAK RPH

Provider Business Mailing Address
First Line	:	5353 W 11000 N
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9403
Country	:	US
Telephone Number	:	801-756-8353
Fax Number	:	801-756-3525

Provider Business Practice Location Address
First Line	:	5353 W 11000 N
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9403
Country	:	US
Telephone Number	:	801-756-8353
Fax Number	:	801-756-3525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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