Provider Demographics
NPI:1659835593
Name:CORRA, LORRAINE (RPH, BCGP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:CORRA
Suffix:
Gender:F
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:FORT HARRISON
Mailing Address - State:MT
Mailing Address - Zip Code:59636-0225
Mailing Address - Country:US
Mailing Address - Phone:406-868-4372
Mailing Address - Fax:
Practice Address - Street 1:3687 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636-0190
Practice Address - Country:US
Practice Address - Phone:406-447-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1835P0018XOtherVA HEALTHCARE