Provider Demographics
NPI:1699197178
Name:RABUN, CORRI R (RPH)
Entity Type:Individual
Prefix:
First Name:CORRI
Middle Name:R
Last Name:RABUN
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 1:2153 MARION MOUNT GILEAD RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8990
Mailing Address - Country:US
Mailing Address - Phone:740-389-0510
Mailing Address - Fax:740-389-0565
Practice Address - Street 1:2153 MARION MOUNT GILEAD RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8990
Practice Address - Country:US
Practice Address - Phone:740-389-0510
Practice Address - Fax:740-389-0565
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist