Provider Demographics
NPI:1922376060
Name:CORDISCO, CAROLINE M (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:CORDISCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 CRIDER RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2355
Mailing Address - Country:US
Mailing Address - Phone:724-816-2070
Mailing Address - Fax:724-776-7237
Practice Address - Street 1:6905 CRIDER RD
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2355
Practice Address - Country:US
Practice Address - Phone:724-816-2070
Practice Address - Fax:724-776-7237
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041071L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist