# CORNELL PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cornell Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265597272
- **Authorized official:** MR. JOSHUA J. PROHASKA (OWNER)
- **Authorized official phone:** (715) 239-6453

## Contact information

- **Practice address:** 300 MAIN ST, CORNELL, WI 54732-8384
- **Practice address phone:** (715) 239-6453
- **Practice address fax:** (715) 239-6078
- **Mailing address:** PO BOX 554, 300 MAIN ST., CORNELL, WI 54732-0554
- **Mailing address phone:** (715) 239-6453
- **Mailing address fax:** (715) 239-6078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8857-42 | WI | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 10/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 36228500 | — | WI |
| 01 | — | 8857-42 | WI STATE ID \# | — |