Provider Demographics
NPI:1063003713
Name:MAGPHARM CONSULTING
Entity Type:Organization
Organization Name:MAGPHARM CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORKREAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-206-4970
Mailing Address - Street 1:12525 CURLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7094
Mailing Address - Country:US
Mailing Address - Phone:352-206-4970
Mailing Address - Fax:352-588-3337
Practice Address - Street 1:12525 CURLEY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-7094
Practice Address - Country:US
Practice Address - Phone:352-206-4970
Practice Address - Fax:352-588-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty