Active NPI
Antonio Cordova, PHARMD
- Pharmacist
- Pueblo, CO
National Provider Identifier
1104151455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16928
- Practice address
- 3670 Parker Blvd
Suite 200
Pueblo, CO 81008-2207 - Phone
- (719) 595-5367
- NPI assigned
- Oct 5, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16928 | CO | Primary |
Addresses
Primary practice location
3670 Parker Blvd
Suite 200
Pueblo, CO 81008-2207
Mailing address
3670 Parker Blvd
Pueblo, CO 81008-2285
Phone (719) 595-5367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16928 | CO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415577600000",
"number": "1104151455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3670 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082285",
"telephone_number": "719-595-5367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3670 PARKER BLVD",
"address_2": "SUITE 200",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082207",
"telephone_number": "719-595-5367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "ANTONIO",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-05",
"last_updated": "2014-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "16928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.