Healthcare Provider Details

I. General information

NPI: 1215297890
Provider Name (Legal Business Name): THE CORNER APOTHECARY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S MAIN ST
CAMDEN DE
19934-1319
US

IV. Provider business mailing address

PO BOX 402
CAMDEN DE
19934-0402
US

V. Phone/Fax

Practice location:
  • Phone: 302-387-1590
  • Fax: 302-387-1744
Mailing address:
  • Phone: 302-387-1590
  • Fax: 302-387-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA3-0000931
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberA30000931
License Number StateDE

VIII. Authorized Official

Name: SANDRA ZARAGOZA
Title or Position: OWNER/CEO
Credential:
Phone: 302-387-1590