Provider Demographics
NPI:1689279481
Name:CORDOR, STEPHEN P
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:CORDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRONT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1446
Mailing Address - Country:US
Mailing Address - Phone:508-752-6001
Mailing Address - Fax:508-792-6770
Practice Address - Street 1:110 FRONT ST STE 102
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1446
Practice Address - Country:US
Practice Address - Phone:508-752-6001
Practice Address - Fax:508-792-6770
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist