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General NPI Number Information
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NPI Number | 1023014255
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Entity Type | Organization
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Legal Business Name | CORNELLS PHARMACY LLC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 140 MANSFIELD AVE
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City | SHELBY
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State | OH
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Zip | 44875-1833
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Country | US
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Telephone | 419-347-2033
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Fax | 419-347-2053
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Provider Business Mailing Address
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Address Line | PO BOX 645
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City | SHELBY
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State | OH
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Zip | 44875-0645
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Country | US
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Telephone | 419-347-2033
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Fax | 419-347-2053
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Authorized Official
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Title or Position | MANAGER
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Name | MARCIA TRISKA
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Credential | RPH
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Telephone | 419-374-2033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021274650
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License Number State | OH
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