Active NPI
Phil Cordova
- Pharmacist
- Albuquerque, NM
National Provider Identifier
1215762281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4518
- Practice address
- 2720 Broadbent Pkwy NE
Albuquerque, NM 87107-1628 - Phone
- (505) 269-4828
- NPI assigned
- Sep 7, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 4518 | NM | Primary |
Addresses
Primary practice location
2720 Broadbent Pkwy NE
Albuquerque, NM 87107-1628
Mailing address
14013 Mesita Cliff Rd NE
Albuquerque, NM 87112-6580
Phone (505) 269-4828
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4518 | NM | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725667200000",
"number": "1215762281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14013 MESITA CLIFF RD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871126580",
"telephone_number": "505-269-4828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 BROADBENT PKWY NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871071628",
"telephone_number": "505-269-4828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "PHIL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-07",
"last_updated": "2024-09-07",
"certification_date": "2024-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "4518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.