Provider Demographics
NPI:1912280009
Name:CORDOVA, DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CORDOVA
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 1:1201 NE 26TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1206
Mailing Address - Country:US
Mailing Address - Phone:954-568-3789
Mailing Address - Fax:
Practice Address - Street 1:1201 NE 26TH ST STE 110
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1206
Practice Address - Country:US
Practice Address - Phone:954-568-3789
Practice Address - Fax:954-568-3210
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist