Provider Demographics
NPI:1770881039
Name:CORDOVA, WILLIAM BENJAMIN SR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:CORDOVA
Suffix:SR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 E 1350 N
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3410
Mailing Address - Country:US
Mailing Address - Phone:435-671-8870
Mailing Address - Fax:
Practice Address - Street 1:1460 E 1350 N
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3410
Practice Address - Country:US
Practice Address - Phone:435-671-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5797197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist