Provider Demographics
NPI:1518257088
Name:KORNET, JOHN M
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:KORNET
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 1:3444 KEITHSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4109
Mailing Address - Country:US
Mailing Address - Phone:859-223-9547
Mailing Address - Fax:
Practice Address - Street 1:2700 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1503
Practice Address - Country:US
Practice Address - Phone:859-269-5396
Practice Address - Fax:859-269-1028
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist