MEDICARE: DOMINIC CORDISCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS59926	FL

General Provider Information

NPI Number	:	1407466840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC CORDISCO

Provider Business Mailing Address
First Line	:	211 HANCOCK BRIDGE PKWY UNIT 7
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-4022
Country	:	US
Telephone Number	:	239-677-4945
Fax Number	:	239-800-4854

Provider Business Practice Location Address
First Line	:	211 HANCOCK BRIDGE PKWY UNIT 7
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-4022
Country	:	US
Telephone Number	:	239-677-4945
Fax Number	:	239-800-4854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	07/31/2020

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Directions to “ DOMINIC CORDISCO ” Practice Location

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