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NPI Code Detail

MEDICARE: DR. JASON LOREN CORNISH PHARM.D.

MEDICARE: DR. JASON LOREN CORNISH PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist43242TX

General Provider Information

NPI Number : 1538148903
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON LOREN CORNISH PHARM.D.
Provider Business Mailing Address
First Line : 4213 THEO ST
Second Line :
City : BIG SPRING
State : TX
Zip : 79720-7027
Country : US
Telephone Number : 432-935-6125
Fax Number :
Provider Business Practice Location Address
First Line : 300 W VETERANS BLVD
Second Line : PHARMACY SERVICE
City : BIG SPRING
State : TX
Zip : 79720-5566
Country : US
Telephone Number : 432-264-4836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 07/08/2007

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