Healthcare Provider Details

I. General information

NPI: 1659835593
Provider Name (Legal Business Name): LORRAINE CORRA RPH, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DRIVE
FORT HARRISON MT
59636-0190
US

IV. Provider business mailing address

PO BOX 225
FORT HARRISON MT
59636-0225
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-7571
  • Fax:
Mailing address:
  • Phone: 406-868-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3579
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: