Provider Demographics
NPI:1952420101
Name:CORNETT, CHERYL J
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:CORNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3633
Mailing Address - Country:US
Mailing Address - Phone:817-538-6910
Mailing Address - Fax:
Practice Address - Street 1:3881 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3633
Practice Address - Country:US
Practice Address - Phone:334-271-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14687183500000X
TX43292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14687OtherPHARMACIST LICENSE