Organization
JACK J CORDOVA
Active
Organization
JACK J CORDOVA
Active
Other names
GEORGETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACK CORDOVA (OWNER)
(206) 763-0288
Entity
Organization
Contact information
Practice address
6111 13TH AVE S, SEATTLE, WA 98108-2705
(206) 763-0288
(206) 768-1296
Mailing address
6111 13TH AVE S, SEATTLE, WA 98108-2705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00000300
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4906775
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6030407
—
WA
Enumeration date
02/12/2007
Last updated
03/09/2009
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