Healthcare Provider Details

I. General information

NPI: 1881227742
Provider Name (Legal Business Name): KORNER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11042 STATE ROUTE 525 STE 130
CLINTON WA
98236-8616
US

IV. Provider business mailing address

3326 MADRONA BEACH RD NW
OLYMPIA WA
98502-8868
US

V. Phone/Fax

Practice location:
  • Phone: 360-451-3359
  • Fax:
Mailing address:
  • Phone: 360-451-3359
  • Fax:

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL MCCARTY
Title or Position: PIC
Credential:
Phone: 360-451-3359