Justin Robert Cornewell, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

26026818A Issued in IN

Practice address

2121 Lake Ave
Fort Wayne, IN 46805-5100

Phone

(260) 426-5431

NPI assigned

Oct 26, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1750153318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11854 HIGHLINE CT",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460609408",
            "telephone_number": "260-479-7078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNEWELL",
        "first_name": "JUSTIN",
        "middle_name": "ROBERT",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IN",
            "license": "26026818A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Louis Corey II, MD
• Samuel Louis Corey, D.D.S.
• Elise Cormany, OTR/L
• Cornerstone Caregiving East LLC
• Cornerstone Counseling & Consulting, P.C,
• Kimberly Paige Cornman, MA, BCBA
• Carissa Cornwall, RBT
• Pamela S Cornwell, NP
• Gina Coronato
• Kit J Corps, MA, LMHCA

• All providers in Fort Wayne, IN
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; 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.