Provider Demographics
NPI:1720425739
Name:CORNELISON, RENEE CHRISTINE (RPH)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CHRISTINE
Last Name:CORNELISON
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 1:5290 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2004
Mailing Address - Country:US
Mailing Address - Phone:334-207-2861
Mailing Address - Fax:
Practice Address - Street 1:5290 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-2004
Practice Address - Country:US
Practice Address - Phone:334-207-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist