MEDICARE: MS. PATRICIA L CORNWELL

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
1	183500000X	Pharmacist	13281	AL

General Provider Information

NPI Number	:	1750371712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA L CORNWELL

Provider Business Mailing Address
First Line	:	300 TWINING ST BLDG 760
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36112-6027
Country	:	US
Telephone Number	:	334-953-8833
Fax Number	:	334-953-5272

Provider Business Practice Location Address
First Line	:	300 TWINING ST BLDG 760
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36112-6027
Country	:	US
Telephone Number	:	334-953-8833
Fax Number	:	334-953-5272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/20/2018

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