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General NPI Number Information
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NPI Number | 1114297843
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Entity Type | Individual
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Provider Name | CORDELL CROSS RPH
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Gender | Male
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 5504 BALBOA AVE
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City | SAN DIEGO
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State | CA
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Zip | 92111-2704
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Country | US
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Telephone | 858-268-4071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 881084
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City | SAN DIEGO
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State | CA
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Zip | 92168-1084
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Country | US
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Telephone | 858-268-4071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 30804
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14531
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License Number State | IA
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