Healthcare Provider Details

I. General information

NPI: 1174594220
Provider Name (Legal Business Name): THE CORNER DRUG STORE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N PUBLIC SQ
GREENSBURG KY
42743-1530
US

IV. Provider business mailing address

111 N PUBLIC SQ
GREENSBURG KY
42743-1530
US

V. Phone/Fax

Practice location:
  • Phone: 270-932-5271
  • Fax: 270-932-3711
Mailing address:
  • Phone: 270-932-5271
  • Fax: 270-932-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP00382
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP00382
License Number StateKY

VIII. Authorized Official

Name: MITCHELL COLLINGS
Title or Position: PRES
Credential: RPH
Phone: 270-932-5271