Provider Demographics
NPI:1518308410
Name:CORNISH, JANENE LAVONNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANENE
Middle Name:LAVONNE
Last Name:CORNISH
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 1:3202H W BROOKMYER DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-4051
Mailing Address - Country:US
Mailing Address - Phone:302-943-9985
Mailing Address - Fax:
Practice Address - Street 1:806 BARKWOOD CT STE G
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-1436
Practice Address - Country:US
Practice Address - Phone:410-636-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist