Provider Demographics
NPI:1689822504
Name:CORCORAN, LAUREN RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 664
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-9797
Mailing Address - Country:US
Mailing Address - Phone:406-395-4150
Mailing Address - Fax:406-395-4408
Practice Address - Street 1:RR 1 BOX 664
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9797
Practice Address - Country:US
Practice Address - Phone:406-395-4150
Practice Address - Fax:406-395-4408
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist