MEDICARE: MR. DANIEL HENRY CORDES 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	28772	MO

General Provider Information

NPI Number	:	1902803570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL HENRY CORDES RPH

Provider Business Mailing Address
First Line	:	12931 SUNSET BLUFF CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1303
Country	:	US
Telephone Number	:	314-702-7211
Fax Number	:	314-702-7714

Provider Business Practice Location Address
First Line	:	13900 RIVERPORT DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4804
Country	:	US
Telephone Number	:	314-702-7211
Fax Number	:	314-702-7714

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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