Provider Demographics
NPI:1396960522
Name:CORYAT, MARGARET L (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:L
Last Name:CORYAT
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:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:NM
Mailing Address - Zip Code:87732-0679
Mailing Address - Country:US
Mailing Address - Phone:505-425-6161
Mailing Address - Fax:505-425-8510
Practice Address - Street 1:602 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4248
Practice Address - Country:US
Practice Address - Phone:505-425-6241
Practice Address - Fax:505-425-8510
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00006147OtherPHARMACIST - CATALYST RX