Provider Demographics
NPI:1225429426
Name:CORDUM, CHERRYL DAIGRE (RPH)
Entity Type:Individual
Prefix:
First Name:CHERRYL
Middle Name:DAIGRE
Last Name:CORDUM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 BRASS WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-2001
Mailing Address - Country:US
Mailing Address - Phone:214-331-2268
Mailing Address - Fax:
Practice Address - Street 1:4447 BRASS WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-2001
Practice Address - Country:US
Practice Address - Phone:214-331-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326101835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK16011OtherOKLAHOMA STATE BOARD OF PHARMACY