Healthcare Provider Details

I. General information

NPI: 1225025539
Provider Name (Legal Business Name): GINO S. CORDISCO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 SHEFFIELD RD
ALIQUIPPA PA
15001-2758
US

IV. Provider business mailing address

6905 CRIDER RD
MARS PA
16046-2355
US

V. Phone/Fax

Practice location:
  • Phone: 724-816-2512
  • Fax: 724-776-7237
Mailing address:
  • Phone: 724-816-2512
  • Fax: 724-776-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040055L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP040055L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP040055L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: