Provider Demographics
NPI:1093047334
Name:CORNRICH, BRUCE D (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
Last Name:CORNRICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1618
Mailing Address - Country:US
Mailing Address - Phone:724-651-9911
Mailing Address - Fax:
Practice Address - Street 1:2650 ELLWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-6262
Practice Address - Country:US
Practice Address - Phone:724-658-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034643L183500000X
OH03225294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist