Provider Demographics
NPI:1316138878
Name:KORDECK, EDWARD ANTHONY (RP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANTHONY
Last Name:KORDECK
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1166
Mailing Address - Country:US
Mailing Address - Phone:610-967-5684
Mailing Address - Fax:610-966-6744
Practice Address - Street 1:155 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1166
Practice Address - Country:US
Practice Address - Phone:610-967-5684
Practice Address - Fax:610-966-6744
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033869R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist