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General NPI Number Information
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NPI Number | 1508919119
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Entity Type | Organization
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Legal Business Name | CORNELL CENTRUM PHARMACY
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 8200 E BELLEVIEW AVE 100C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-694-3784
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 E BELLEVIEW AVE 100C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-694-3784
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Fax |
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | MR. TONY E JONES
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Credential | RPH
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Telephone | 303-694-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 370000017
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License Number State | CO
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