Provider Demographics
NPI:1083377519
Name:CORDLE, MARK SHAWN II (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:SHAWN
Last Name:CORDLE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CARAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2934
Mailing Address - Country:US
Mailing Address - Phone:304-573-5484
Mailing Address - Fax:
Practice Address - Street 1:4501 NEWS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7803
Practice Address - Country:US
Practice Address - Phone:757-220-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist