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General NPI Number Information
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NPI Number | 1639594369
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Entity Type | Organization
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Legal Business Name | CORNER DRUG STORES OF KNIGHTDALE, INC
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 6905 KNIGHTDALE BLVD SUITE 102
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6505
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Country | US
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Telephone | 919-261-6999
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Fax | 919-261-6012
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Provider Business Mailing Address
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Address Line | 303 N ARENDELL AVE
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City | ZEBULON
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State | NC
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Zip | 27597-2605
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Country | US
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Telephone | 919-269-9998
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Fax | 919-269-9998
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ADRIAN WYATT ADAMS
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Credential | RPH
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Telephone | 919-261-6999
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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 | 11853
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License Number State | NC
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