Provider Demographics
NPI:1104842046
Name:CORNELL, ROBERT WILLIAM
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:CORNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 STATE ROUTE 89
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541-9779
Mailing Address - Country:US
Mailing Address - Phone:315-549-8790
Mailing Address - Fax:
Practice Address - Street 1:95 FALL ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1408
Practice Address - Country:US
Practice Address - Phone:315-568-1700
Practice Address - Fax:315-568-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist