Provider Demographics
NPI:1104469345
Name:CORNER DRUG & GIFT, INC
Entity type:Organization
Organization Name:CORNER DRUG & GIFT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-454-6614
Mailing Address - Street 1:823 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNS
Mailing Address - State:KS
Mailing Address - Zip Code:67437-1623
Mailing Address - Country:US
Mailing Address - Phone:785-454-6614
Mailing Address - Fax:785-454-6675
Practice Address - Street 1:823 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:DOWNS
Practice Address - State:KS
Practice Address - Zip Code:67437-1623
Practice Address - Country:US
Practice Address - Phone:785-454-6614
Practice Address - Fax:785-454-6675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNER DRUG & GIFT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-21
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200425740AMedicaid