Provider Demographics
NPI:1235409574
Name:CORTEZ, EDMUND L (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:L
Last Name:CORTEZ
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 1:2710 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2730
Mailing Address - Country:US
Mailing Address - Phone:937-277-6022
Mailing Address - Fax:937-277-2629
Practice Address - Street 1:2710 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2730
Practice Address - Country:US
Practice Address - Phone:937-277-6022
Practice Address - Fax:937-277-2629
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist