Provider Demographics
NPI:1225025539
Name:CORDISCO, GINO S (RPH)
Entity Type:Individual
Prefix:MR
First Name:GINO
Middle Name:S
Last Name:CORDISCO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 CRIDER RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2355
Mailing Address - Country:US
Mailing Address - Phone:724-816-2512
Mailing Address - Fax:724-776-7237
Practice Address - Street 1:2003 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2758
Practice Address - Country:US
Practice Address - Phone:724-816-2512
Practice Address - Fax:724-776-7237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040055L183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric