Provider Demographics
NPI:1396220828
Name:CORDOVA, EDMUND J (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:J
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3709
Mailing Address - Country:US
Mailing Address - Phone:630-715-1767
Mailing Address - Fax:
Practice Address - Street 1:1901 W 22ND ST FL 1
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1785
Practice Address - Country:US
Practice Address - Phone:630-928-0220
Practice Address - Fax:630-928-0567
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301590183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist