Individual
DR. MARK G CORRALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.PH.
Contact information
Practice address
1810 W GORE BLVD, LAWTON, OK 73501-3615
(580) 355-4540
(580) 248-2012
Mailing address
1810 W GORE BLVD, LAWTON, OK 73501-3615
(580) 355-4540
(580) 248-2012
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11511
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11511
PHARMACIST LICENSE NUMBER
OK
Enumeration date
01/24/2007
Last updated
07/08/2007
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