MEDICARE: LARRY CORDES R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	TX30354	TX

General Provider Information

NPI Number	:	1437659430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY CORDES R.PH.

Provider Business Mailing Address
First Line	:	3317 N MIDLAND DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-4602
Country	:	US
Telephone Number	:	432-689-8708
Fax Number	:	432-697-3959

Provider Business Practice Location Address
First Line	:	3317 N MIDLAND DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-4602
Country	:	US
Telephone Number	:	432-689-8708
Fax Number	:	432-697-3959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	02/15/2018

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