Provider Demographics
NPI:1275800229
Name:CORRALES, JOANN LOZADA (RPH)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:LOZADA
Last Name:CORRALES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18647 SUNSET KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9447
Mailing Address - Country:US
Mailing Address - Phone:951-313-2508
Mailing Address - Fax:
Practice Address - Street 1:16020 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-4618
Practice Address - Country:US
Practice Address - Phone:951-247-2113
Practice Address - Fax:951-247-2762
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 47802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist