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General NPI Number Information
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NPI Number | 1124122171
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Entity Type | Organization
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Legal Business Name | CORNING DRUG INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 1322 SOLANO ST
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City | CORNING
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State | CA
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Zip | 96021-3053
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Country | US
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Telephone | 530-824-3495
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Fax | 530-824-9227
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Provider Business Mailing Address
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Address Line | 1322 SOLANO ST
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City | CORNING
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State | CA
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Zip | 96021-3053
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Country | US
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Telephone | 530-824-3495
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Fax | 530-824-9227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID BILODEAUX
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Credential |
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Telephone | 530-824-3495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51025
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License Number State | CA
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