Provider Demographics
NPI:1134981970
Name:MICHAEL'S PRESCRIPTION CORNER LLC
Entity type:Organization
Organization Name:MICHAEL'S PRESCRIPTION CORNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RABURN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:575-396-2311
Mailing Address - Street 1:310 CONTINENTAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JAL
Mailing Address - State:NM
Mailing Address - Zip Code:88252
Mailing Address - Country:US
Mailing Address - Phone:575-397-2311
Mailing Address - Fax:575-395-8095
Practice Address - Street 1:310 CONTINENTAL
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-397-2311
Practice Address - Fax:575-395-8095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL'S PRESCRIPTION CORNER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy