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General NPI Number Information
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NPI Number | 1811070881
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Entity Type | Organization
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Legal Business Name | THE CORNER DRUGSTORE INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 3110 W CLAY ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1022
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Country | US
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Telephone | 636-946-3866
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Fax | 636-724-1451
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Provider Business Mailing Address
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Address Line | 3110 W CLAY ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1022
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Country | US
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Telephone | 636-946-3866
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD ROBERTS
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Credential | RPH CF
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Telephone | 636-946-6557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 004712
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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