Healthcare Provider Details

I. General information

NPI: 1073546347
Provider Name (Legal Business Name): CORNER DRUG & GIFT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MORGAN AVE
DOWNS KS
67437-1623
US

IV. Provider business mailing address

823 MORGAN AVE
DOWNS KS
67437-1623
US

V. Phone/Fax

Practice location:
  • Phone: 785-454-6614
  • Fax: 785-454-6675
Mailing address:
  • Phone: 785-454-6614
  • Fax: 785-454-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number209402
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200425740A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: SHAWNA MARIE DOANE
Title or Position: OWNER/PIC
Credential:
Phone: 785-454-6614