Provider Demographics
NPI:1215297890
Name:THE CORNER APOTHECARY, INC
Entity type:Organization
Organization Name:THE CORNER APOTHECARY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARAGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-387-1590
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-0402
Mailing Address - Country:US
Mailing Address - Phone:302-387-1590
Mailing Address - Fax:302-387-1744
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1319
Practice Address - Country:US
Practice Address - Phone:302-387-1590
Practice Address - Fax:302-387-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-00009313336C0003X
DEA300009313336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0845264OtherNCPDP PROVIDER IDENTIFICATION NUMBER