=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962010694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNING HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2020
-----------------------------------------------------
Last Update Date | 07/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GUTHRIE DRIVE CORNING HOSPITAL OUTPATIENT PHARMACY
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-887-2800
-----------------------------------------------------
Fax | 570-887-2827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GUTHRIE SQUARE CLINIC PHARMACY
-----------------------------------------------------
City | SAYRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-887-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, OUTPATIENT PHARMACY
-----------------------------------------------------
Name | JOSEPH EDWARD MIHALEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-887-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------