MEDICARE: CHERYL J CORNETT

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	14687	AL
2	183500000X	Pharmacist	43292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14687	OTHER	AL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1952420101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL J CORNETT

Provider Business Mailing Address
First Line	:	3881 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-3633
Country	:	US
Telephone Number	:	817-538-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3881 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-3633
Country	:	US
Telephone Number	:	334-271-5174
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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