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General NPI Number Information
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NPI Number | 1174689616
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Entity Type | Organization
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Legal Business Name | CORCORAN HEALTHCARE ENTERPRISES, INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115 2ND ST
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City | REEDSBURG
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State | WI
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Zip | 53959-1602
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Country | US
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Telephone | 608-524-3215
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Fax | 608-524-8410
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Provider Business Mailing Address
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Address Line | 115 2ND ST PO BOX 245
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City | REEDSBURG
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State | WI
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Zip | 53959-1602
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Country | US
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Telephone | 608-524-3215
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Fax | 608-524-8410
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Authorized Official
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Title or Position | MANAGER
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Name | CINDY L. KISSACK
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Credential | RPH
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Telephone | 608-524-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11077
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License Number State | WI
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