MEDICARE: JOEL A CORDERO RPH

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	004728	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2066092	OTHER	PR	DRIVER LICENSE

General Provider Information

NPI Number	:	1730434135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL A CORDERO RPH

Provider Business Mailing Address
First Line	:	486 CALLE DE DIEGO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3141
Country	:	US
Telephone Number	:	787-763-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	486 CALLE DE DIEGO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3141
Country	:	US
Telephone Number	:	787-763-0255
Fax Number	:

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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