Organization
MICHAEL'S PRESCRIPTION CORNER
Active
Other names
MICHAEL'S PRESCRIPTION CORNER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RABURN (OWNER)
(505) 396-2311
Entity
Organization
Contact information
Practice address
123 W AVENUE A, LOVINGTON, NM 88260-4211
(575) 396-2311
(575) 396-2321
Mailing address
123 W AVENUE A, LOVINGTON, NM 88260-4211
(575) 396-2311
(575) 396-2321
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CS00208480
NM
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3202873
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
55061
—
NM
Enumeration date
02/08/2007
Last updated
03/18/2022
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