Provider Demographics
NPI:1316958986
Name:CORNER DRUG CO INC
Entity type:Organization
Organization Name:CORNER DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:865-426-2851
Mailing Address - Street 1:P0 BOX 455
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:TN
Practice Address - Zip Code:37769
Practice Address - Country:US
Practice Address - Phone:865-426-2851
Practice Address - Fax:865-426-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TNTN595333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4408161OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4408161OtherOTHER ID NUMBER-COMMERCIAL NUMBER