Provider Demographics
NPI:1750618724
Name:LEDFORD, CORY (RPH)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 E. EL DORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0000
Mailing Address - Country:US
Mailing Address - Phone:972-987-4106
Mailing Address - Fax:972-987-4138
Practice Address - Street 1:2774 E. EL DORADO PARKWAY
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-0000
Practice Address - Country:US
Practice Address - Phone:972-987-4106
Practice Address - Fax:972-987-4138
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX041292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist