Healthcare Provider Details

I. General information

NPI: 1821416751
Provider Name (Legal Business Name): MICHAEL'S PRESCRIPTION CORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 N FOWLER ST
HOBBS NM
88240-2347
US

IV. Provider business mailing address

2420 N FOWLER ST
HOBBS NM
88240-2347
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-2311
  • Fax: 575-392-2321
Mailing address:
  • Phone: 575-392-2311
  • Fax: 575-392-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003659
License Number StateNM

VIII. Authorized Official

Name: MICHAEL RABURN
Title or Position: OWNER
Credential: RPH
Phone: 575-392-2311