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General NPI Number Information
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NPI Number | 1356472906
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Entity Type | Individual
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Provider Name | BRENTON JAMES CORNWELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4205 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2246
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Country | US
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Telephone | 330-856-1794
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Fax |
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Provider Business Mailing Address
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Address Line | 2152 S RACCOON RD #40
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City | AUSTINTOWN
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State | OH
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Zip | 44515-5215
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Country | US
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Telephone | 330-270-3446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-3-26829
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License Number State | OH
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