Active NPI
Susan Correa Mukatis, RPH
- Pharmacist
- Corvallis, OR
National Provider Identifier
1467585679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 7699
- Practice address
- 3517 NW Samaritan Dr
Suite 201
Corvallis, OR 97330-3767 - Phone
- (541) 768-5185
- Fax
- (541) 768-6585
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7699 | OR | Primary |
Addresses
Primary practice location
3517 NW Samaritan Dr
Suite 201
Corvallis, OR 97330-3767
Mailing address
2851 NW Monterey PL
Corvallis, OR 97330-3435
Phone (541) 758-2658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7699 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467585679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2851 NW MONTEREY PL",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303435",
"telephone_number": "541-758-2658",
"fax_number": "541-768-6585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3517 NW SAMARITAN DR",
"address_2": "SUITE 201",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303767",
"telephone_number": "541-768-5185",
"fax_number": "541-768-6585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKATIS",
"first_name": "SUSAN",
"middle_name": "CORREA",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "7699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.