Provider Demographics
NPI:1316252091
Name:CORACIDES, SOFIA RITA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:RITA
Last Name:CORACIDES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 E NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2160
Mailing Address - Country:US
Mailing Address - Phone:480-775-3809
Mailing Address - Fax:
Practice Address - Street 1:746 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5613
Practice Address - Country:US
Practice Address - Phone:480-668-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist