Provider Demographics
NPI:1265726632
Name:CORNELL, STEVAN DOUGLAS (RPH)
Entity type:Individual
Prefix:
First Name:STEVAN
Middle Name:DOUGLAS
Last Name:CORNELL
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 1:2880 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4397
Mailing Address - Country:US
Mailing Address - Phone:780-782-1992
Mailing Address - Fax:480-782-1992
Practice Address - Street 1:2880 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4397
Practice Address - Country:US
Practice Address - Phone:780-782-1992
Practice Address - Fax:480-782-1992
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS7419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist