Healthcare Provider Details

I. General information

NPI: 1609900042
Provider Name (Legal Business Name): EDWIN SCOTT CORNELIUS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 3RD STREET S.W
ATTALLA AL
35954-0490
US

IV. Provider business mailing address

115 ARROW WOOD LN
GADSDEN AL
35901-8611
US

V. Phone/Fax

Practice location:
  • Phone: 256-538-5850
  • Fax: 256-538-1860
Mailing address:
  • Phone: 256-442-9446
  • Fax: 256-538-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14587
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: