Provider Demographics
NPI:1659583987
Name:GRUM, CORNELIA DORA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:DORA
Last Name:GRUM
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 1:165 JACOBS RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:13315-3325
Mailing Address - Country:US
Mailing Address - Phone:607-965-6628
Mailing Address - Fax:
Practice Address - Street 1:12 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411
Practice Address - Country:US
Practice Address - Phone:607-847-8181
Practice Address - Fax:607-847-8130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist