Active NPI
Michael Charles Cornwall, RPH
- Pharmacist
- O Fallon, IL
National Provider Identifier
1376194134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 041484
- Practice address
- 21 Shallowbrook Dr
O Fallon, IL 62269-1214 - Phone
- (618) 977-5537
- NPI assigned
- Sep 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 041484 | MO | Primary |
Addresses
Primary practice location
21 Shallowbrook Dr
O Fallon, IL 62269-1214
Mailing address
21 Shallowbrook Dr
O Fallon, IL 62269-1214
Phone (618) 977-5537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041484 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569283200000",
"number": "1376194134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 SHALLOWBROOK DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691214",
"telephone_number": "618-977-5537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 SHALLOWBROOK DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691214",
"telephone_number": "618-977-5537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNWALL",
"first_name": "MICHAEL",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-24",
"last_updated": "2019-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "041484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.