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General NPI Number Information
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NPI Number | 1265597272
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Entity Type | Organization
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Legal Business Name | CORNELL PHARMACY, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 300 MAIN ST
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City | CORNELL
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State | WI
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Zip | 54732-8384
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Country | US
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Telephone | 715-239-6453
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Fax | 715-239-6078
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Provider Business Mailing Address
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Address Line | PO BOX 554 300 MAIN ST.
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City | CORNELL
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State | WI
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Zip | 54732-0554
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Country | US
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Telephone | 715-239-6453
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Fax | 715-239-6078
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSHUA J. PROHASKA
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Credential |
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Telephone | 715-239-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 8857-42
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License Number State | WI
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