Healthcare Provider Details

I. General information

NPI: 1316295967
Provider Name (Legal Business Name): ANNE LESLIE CORDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR SUITE 180
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

841 PRUDENTIAL DR SUITE 180
JACKSONVILLE FL
32207-8329
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-4243
  • Fax: 904-376-3746
Mailing address:
  • Phone: 904-202-4243
  • Fax: 904-376-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS22495
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS22495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: