# CORNELLS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CORNELLS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023014255
- **Authorized official:** MARCIA TRISKA RPH (MANAGER)
- **Authorized official phone:** (419) 374-2033

## Contact information

- **Practice address:** 140 MANSFIELD AVE, SHELBY, OH 44875-1833
- **Practice address phone:** (419) 347-2033
- **Practice address fax:** (419) 347-2053
- **Mailing address:** PO BOX 645, SHELBY, OH 44875-0645
- **Mailing address phone:** (419) 347-2033
- **Mailing address fax:** (419) 347-2053

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 021274650 | OH | Yes |

## Other

- **Enumeration date:** 06/22/2005
- **Last updated:** 03/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2256320 | — | OH |
| 01 | — | 3669554 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |