Healthcare Provider Details

I. General information

NPI: 1366583908
Provider Name (Legal Business Name): CORNER DRUG STORE OF STURGIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N ADAMS ST
STURGIS KY
42459-1611
US

IV. Provider business mailing address

424 N ADAMS ST
STURGIS KY
42459-1611
US

V. Phone/Fax

Practice location:
  • Phone: 270-333-5344
  • Fax: 270-333-4513
Mailing address:
  • Phone: 270-333-5344
  • Fax: 270-333-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO6940
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO6940
License Number StateKY

VIII. Authorized Official

Name: MR. ANTHONY DAREN WARFORD
Title or Position: PHARMACIST
Credential:
Phone: 270-333-5344