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General NPI Number Information
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NPI Number | 1306038724
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Entity Type | Organization
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Legal Business Name | THE CORNER PHARMACY
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 4901 KELLER SPRINGS RD SUITE 108
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City | ADDISON
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State | TX
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Zip | 75001-5930
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Country | US
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Telephone | 469-828-4414
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Fax | 469-828-4426
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Provider Business Mailing Address
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Address Line | 4901 KELLER SPRINGS RD SUITE 108
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City | ADDISON
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State | TX
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Zip | 75001-5930
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Country | US
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Telephone | 469-828-4414
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Fax | 469-828-4426
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY OPERATIONS
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Name | MR. PHIL WORRELL
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Credential | R.PH., J.D.
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Telephone | 314-330-5597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 25674
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License Number State | TX
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