Provider Demographics
NPI:1922272681
Name:CORAK, JOSEPH M (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:CORAK
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 1:5353 W 11000 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9403
Mailing Address - Country:US
Mailing Address - Phone:801-756-8353
Mailing Address - Fax:801-756-3525
Practice Address - Street 1:5353 W 11000 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9403
Practice Address - Country:US
Practice Address - Phone:801-756-8353
Practice Address - Fax:801-756-3525
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146862-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist