Healthcare Provider Details

I. General information

NPI: 1518820430
Provider Name (Legal Business Name): THE CORNER DRUG AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 JACKSON ST
ALEXANDRIA LA
71303-2752
US

IV. Provider business mailing address

350 W SHORE DR
ALEXANDRIA LA
71303-7006
US

V. Phone/Fax

Practice location:
  • Phone: 318-709-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AUSTIN PEAVY
Title or Position: OWNER
Credential: PHARMD
Phone: 318-709-8262