Provider Demographics
NPI:1740883313
Name:CORDOVA, GENESIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GENESIS
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 HUNTINGDON PIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8362
Mailing Address - Country:US
Mailing Address - Phone:215-379-3257
Mailing Address - Fax:215-379-3275
Practice Address - Street 1:737 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8362
Practice Address - Country:US
Practice Address - Phone:215-379-3257
Practice Address - Fax:215-379-3275
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist