Healthcare Provider Details

I. General information

NPI: 1679341572
Provider Name (Legal Business Name): KENNETH JOEL CORTES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR # CC101GH
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 787-942-5590
  • Fax:
Mailing address:
  • Phone: 787-942-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25368
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008427
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48313
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: