Healthcare Provider Details

I. General information

NPI: 1407412802
Provider Name (Legal Business Name): CORNER CHEMISTS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HENRY STREET
NEW YORK NY
10038
US

IV. Provider business mailing address

11 HENRY STREET
NEW YORK NY
10038
US

V. Phone/Fax

Practice location:
  • Phone: 646-869-8881
  • Fax: 646-869-8885
Mailing address:
  • Phone: 646-869-8881
  • Fax: 646-869-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. GIGI LIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 646-869-8881