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General NPI Number Information
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NPI Number | 1164974036
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Entity Type | Organization
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Legal Business Name | CORCORAN HEALTHCARE ENT INC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 301 E 2ND ST
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-1900
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Country | US
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Telephone | 608-647-8806
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Fax | 608-647-2029
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Provider Business Mailing Address
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Address Line | 301 E 2ND ST PO BOX 309
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-1900
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Country | US
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Telephone | 608-647-8806
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Fax | 608-647-2029
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Authorized Official
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Title or Position | OWNER
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Name | PAUL F CORCORAN
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Credential | RPH
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Telephone | 608-647-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 7973-042
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 7973-042
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License Number State | WI
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