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Organization
CORNELLS PHARMACY LLC
Active
Organization
CORNELLS PHARMACY LLC
Active
Other names
CORNELLS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIA TRISKA RPH (MANAGER)
(419) 374-2033
Entity
Organization
Contact information
Practice address
140 MANSFIELD AVE, SHELBY, OH 44875-1833
(419) 347-2033
(419) 347-2053
Mailing address
PO BOX 645, SHELBY, OH 44875-0645
(419) 347-2033
(419) 347-2053
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
021274650
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2256320
—
OH
01
—
3669554
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/22/2005
Last updated
03/08/2011
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