Provider Demographics
NPI:1487024261
Name:MCGUINN-PARKS, CORY (RPH)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:MCGUINN-PARKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 SAND SAGE RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4852
Mailing Address - Country:US
Mailing Address - Phone:505-565-8450
Mailing Address - Fax:
Practice Address - Street 1:549 SAND SAGE RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4852
Practice Address - Country:US
Practice Address - Phone:505-565-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist