MEDICARE: CORNER DRUG STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	09206	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2065497	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477599850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNER DRUG STORES INC

Provider Business Mailing Address
First Line	:	23 EAST HIGHWAY 98
Second Line	:	SUITE 100
City	:	BUNN
State	:	NC
Zip	:	27508
Country	:	US
Telephone Number	:	919-497-1700
Fax Number	:	919-497-1777

Provider Business Practice Location Address
First Line	:	23 EAST HIGHWAY 98
Second Line	:	SUITE 100
City	:	BUNN
State	:	NC
Zip	:	27508
Country	:	US
Telephone Number	:	919-497-1700
Fax Number	:	919-497-1777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADRIAN ADAMS
Credential	:	BS PHARM
Telephone Number	:	919-269-7481

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/24/2020

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