Provider Demographics
NPI:1740394592
Name:CORDERO, MARIE ANTONNETTE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:ANTONNETTE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NW 16TH STREET
Mailing Address - Street 2:VA MEDICAL CENTER #19
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-324-4455
Mailing Address - Fax:305-575-3386
Practice Address - Street 1:1201 NW 16TH STREET
Practice Address - Street 2:VA MEDICAL CENTER #19
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-324-4455
Practice Address - Fax:305-575-3386
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPS 38593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist