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General NPI Number Information
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NPI Number | 1669826178
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Entity Type | Organization
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Legal Business Name | T-RX PHARMACY
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 211 HANCOCK BRIDGE PKWY
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City | CAPE CORAL
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State | FL
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Zip | 33990-4021
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Country | US
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Telephone | 239-677-4945
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Fax | 239-800-4854
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Provider Business Mailing Address
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Address Line | 211 HANCOCK BRIDGE PKWY SUITE #7
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City | CAPE CORAL
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State | FL
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Zip | 33990-4021
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Country | US
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Telephone | 239-677-4945
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Fax | 239-800-4854
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PIC/AO
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Name | TERRY CORDISCO
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Credential | RPH
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Telephone | 239-989-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH30057
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License Number State | FL
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