Provider Demographics
NPI:1598097677
Name:CORNACCHIO, GINA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:CORNACCHIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDEPENDENT WAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6301
Mailing Address - Country:US
Mailing Address - Phone:845-278-2700
Mailing Address - Fax:
Practice Address - Street 1:100 INDEPENDENT WAY
Practice Address - Street 2:SUITE G
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-6301
Practice Address - Country:US
Practice Address - Phone:845-278-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist