Provider Demographics
NPI:1336485747
Name:CORNELL, KATHARINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:CORNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S KINGS DR
Mailing Address - Street 2:MYERS PARK CLINIC PHARMACY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2134
Mailing Address - Country:US
Mailing Address - Phone:704-446-1476
Mailing Address - Fax:704-446-1595
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:MYERS PARK CLINIC PHARMACY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1476
Practice Address - Fax:704-446-1595
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08342183500000X
KY007122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist