NPIMap

Organization Active NPI

Cornells Pharmacy LLC

  • Community/Retail Pharmacy
  • Shelby, OH
National Provider Identifier
1023014255
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
021274650 Issued in OH
Legal business name
CORNELLS PHARMACY LLC
Practice address
140 Mansfield Ave
Shelby, OH 44875-1833
Phone
(419) 347-2033
Fax
(419) 347-2053
NPI assigned
Jun 22, 2005
Organization subpart
No

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

140 Mansfield Ave
Shelby, OH 44875
Phone (419) 347-2033

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcia Triska, RPHNPI 1922134980
Title
Manager
Phone
(419) 374-2033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 021274650 OH Primary

Addresses

Primary practice location

140 Mansfield Ave
Shelby, OH 44875-1833

Mailing address

PO Box 645
Shelby, OH 44875-0645
Phone (419) 347-2033

Other identifiers 2

IdentifierTypeStateIssuer
3669554OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2256320MedicaidOH

Other names 1

  • CORNELLS PHARMACY Doing business as

NPI Registry JSON

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1023014255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 645",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448750645",
            "telephone_number": "419-347-2033",
            "fax_number": "419-347-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MANSFIELD AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751833",
            "telephone_number": "419-347-2033",
            "fax_number": "419-347-2053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELLS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "TRISKA",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "419-374-2033",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021274650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3669554",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2256320",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORNELLS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.