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Organization
CORNELL PHARMACY, INC.
Active
Organization
CORNELL PHARMACY, INC.
Active
Other names
Cornell Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSHUA J. PROHASKA (OWNER)
(715) 239-6453
Entity
Organization
Contact information
Practice address
300 MAIN ST, CORNELL, WI 54732-8384
(715) 239-6453
(715) 239-6078
Mailing address
PO BOX 554, 300 MAIN ST., CORNELL, WI 54732-0554
(715) 239-6453
(715) 239-6078
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8857-42
WI
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36228500
—
WI
01
—
8857-42
WI STATE ID #
—
Enumeration date
12/27/2006
Last updated
10/04/2024
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