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General NPI Number Information
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NPI Number | 1386276160
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Entity Type | Organization
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Legal Business Name | CORRALES PHARMACY INC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 221 STATE HIGHWAY 165 # A4 A4
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City | PLACITAS
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State | NM
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Zip | 87043-9514
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Country | US
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Telephone | 505-480-6327
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Fax |
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Provider Business Mailing Address
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Address Line | 221 STATE HIGHWAY 165 # A4 A4
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City | PLACITAS
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State | NM
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Zip | 87043-9514
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Country | US
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Telephone | 505-480-6327
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Fax |
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Authorized Official
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Title or Position | PIC OWNER
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Name | DR. MIKE LEE GALLEGOS
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Credential | PHARMD, PC
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Telephone | 505-480-6327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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