MEDICARE: LAURA SMITH CORNETT R.PH

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	010066	KY

General Provider Information

NPI Number	:	1932421880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA SMITH CORNETT R.PH

Provider Business Mailing Address
First Line	:	4025 POPLAR LEVEL RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1523
Country	:	US
Telephone Number	:	502-458-3274
Fax Number	:	502-458-7897

Provider Business Practice Location Address
First Line	:	4025 POPLAR LEVEL RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1523
Country	:	US
Telephone Number	:	502-458-3274
Fax Number	:	502-458-7897

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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