Provider Demographics
NPI:1841692779
Name:ERNST, CORY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:JOHN
Last Name:ERNST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 14TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2757
Mailing Address - Country:US
Mailing Address - Phone:515-480-8273
Mailing Address - Fax:
Practice Address - Street 1:1008 14TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2757
Practice Address - Country:US
Practice Address - Phone:515-480-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist