MEDICARE: CORY LEDFORD RPH

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	041292	TX

General Provider Information

NPI Number	:	1750618724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY LEDFORD RPH

Provider Business Mailing Address
First Line	:	2774 E. EL DORADO PKWY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0000
Country	:	US
Telephone Number	:	972-987-4106
Fax Number	:	972-987-4138

Provider Business Practice Location Address
First Line	:	2774 E. EL DORADO PARKWAY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0000
Country	:	US
Telephone Number	:	972-987-4106
Fax Number	:	972-987-4138

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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