Healthcare Provider Details

I. General information

NPI: 1669826178
Provider Name (Legal Business Name): T-RX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HANCOCK BRIDGE PKWY
CAPE CORAL FL
33990-4021
US

IV. Provider business mailing address

211 HANCOCK BRIDGE PKWY SUITE #7
CAPE CORAL FL
33990-4021
US

V. Phone/Fax

Practice location:
  • Phone: 239-677-4945
  • Fax: 239-800-4854
Mailing address:
  • Phone: 239-677-4945
  • Fax: 239-800-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH30057
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERRY CORDISCO
Title or Position: OWNER/PRESIDENT/PIC/AO
Credential: RPH
Phone: 239-989-9152