Provider Demographics
NPI:1093162190
Name:CORNISH, ROBIN SUMMERS (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SUMMERS
Last Name:CORNISH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:KAY
Other - Last Name:GARRITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:1427 QUICK RD
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-7916
Mailing Address - Country:US
Mailing Address - Phone:304-341-0257
Mailing Address - Fax:304-341-0557
Practice Address - Street 1:511 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-341-0257
Practice Address - Fax:304-341-0557
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT0007097183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician