Provider Demographics
NPI:1437430634
Name:KORDALSKI, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KORDALSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5631
Mailing Address - Country:US
Mailing Address - Phone:207-744-0712
Mailing Address - Fax:207-744-0718
Practice Address - Street 1:53 PARIS ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5631
Practice Address - Country:US
Practice Address - Phone:207-744-0712
Practice Address - Fax:207-744-0718
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist