Healthcare Provider Details

I. General information

NPI: 1992751143
Provider Name (Legal Business Name): CORNER DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W SPRING ST STE 6
DODGEVILLE WI
53533-1300
US

IV. Provider business mailing address

333 LOWVILLE RD
RIO WI
53960-9437
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3661
  • Fax: 608-935-2661
Mailing address:
  • Phone: 920-992-6800
  • Fax: 920-614-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5538-042
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5538-042
License Number StateWI

VIII. Authorized Official

Name: DANIEL STRAUSE
Title or Position: OWNER
Credential:
Phone: 920-992-6800