MEDICARE: STANLEY CORDELL JR. 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	183500000X	Pharmacist	03-2-21255	OH

General Provider Information

NPI Number	:	1487630182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY CORDELL JR. R.PH.

Provider Business Mailing Address
First Line	:	22160 CENTER RIDGE RD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-3926
Country	:	US
Telephone Number	:	440-356-3287
Fax Number	:	440-356-3290

Provider Business Practice Location Address
First Line	:	22160 CENTER RIDGE RD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-3926
Country	:	US
Telephone Number	:	440-356-3287
Fax Number	:	440-356-3290

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	05/19/2011

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