Healthcare Provider Details

I. General information

NPI: 1912421272
Provider Name (Legal Business Name): CORNER DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 N HIGHLAND ST STE B
WINCHESTER KY
40391-2024
US

IV. Provider business mailing address

4 N HIGHLAND ST STE B
WINCHESTER KY
40391-2024
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-6844
  • Fax: 859-744-2963
Mailing address:
  • Phone: 859-744-6844
  • Fax: 859-744-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07848
License Number StateKY

VIII. Authorized Official

Name: CHRISTOPHER PALUTIS
Title or Position: OWNER
Credential: RPH
Phone: 678-485-5145