Cornell Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8857-42 Issued in WI

Legal business name

CORNELL PHARMACY, INC.

Doing business as

Cornell Pharmacy

Practice address

300 Main St
Cornell, WI 54732-8384

Phone

(715) 239-6453

Fax

(715) 239-6078

NPI assigned

Dec 27, 2006

Last updated

Oct 4, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Joshua J. Prohaska

Title

Owner

Phone

(715) 239-6453

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Cornell Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jane Pearl Stoik, RPH

  • Pharmacist
  • Cornell, WI
  • NPI 1841519931
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1265597272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 554",
            "address_2": "300 MAIN ST.",
            "city": "CORNELL",
            "state": "WI",
            "postal_code": "547320554",
            "telephone_number": "715-239-6453",
            "fax_number": "715-239-6078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN ST",
            "city": "CORNELL",
            "state": "WI",
            "postal_code": "547328384",
            "telephone_number": "715-239-6453",
            "fax_number": "715-239-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "PROHASKA",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-239-6453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8857-42",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36228500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI STATE ID #",
            "identifier": "8857-42",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornell Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kim Bergh, PTA
• Janis Cekan, APNP
• Cornell Area Ambulance Service
• Cornell Chiropractic, LLC
• Cornell School District
• Alicia Hartung Duerst, DPT
• Extendicare Homes, Inc. (Cornell Area Care Center)
• FMG North 7TH Street Wisconsin LLC (Cornell Area Care)
• Kathryn Franzen, COTA

• Community/Retail Pharmacy in Cornell, WI
• Providers in Cornell, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.