Jack J Cordova

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00000300 Issued in WA

Legal business name

JACK J CORDOVA

Doing business as

GEORGETOWN PHARMACY

Practice address

6111 13TH Ave S
Seattle, WA 98108-2705

Phone

(206) 763-0288

Fax

(206) 768-1296

NPI assigned

Feb 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Cordova

Title

Owner

Phone

(206) 763-0288

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GEORGETOWN PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236556800000",
    "number": "1932240892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6111 13TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981082705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6111 13TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981082705",
            "telephone_number": "206-763-0288",
            "fax_number": "206-768-1296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK J CORDOVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2009-03-09",
        "status": "A",
        "authorized_official_last_name": "CORDOVA",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-763-0288"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00000300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4906775",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6030407",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GEORGETOWN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ebrima Jabbi
• Farrah Jabeen, MBBCH,MRCS,FRCR
• Peter P Jabin, M.DIV., LMHCA
• Michael Thomas Jacezko
• David Paul Jachim, PH.D.
• Andrew Steven Jack, MD, MSC, FRCSC
• Keira Jack
• Andrew Ryan Jackenheimer, M.D.
• Sarah E. Jackins, PT
• Renee Jackman

• Community/Retail Pharmacy in Seattle, WA
• Providers in Seattle, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.