Healthcare Provider Details

I. General information

NPI: 1760428148
Provider Name (Legal Business Name): THE CORNER DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 CORNER SCHOOL RD
WARRIOR AL
35180
US

IV. Provider business mailing address

10107 CORNER SCHOOL RD
WARRIOR AL
35180
US

V. Phone/Fax

Practice location:
  • Phone: 205-647-5454
  • Fax: 205-647-5480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112746
License Number StateAL

VIII. Authorized Official

Name: DARREN MORTON
Title or Position: OWNER
Credential: PHARMD
Phone: 205-647-5454