Provider Demographics
NPI:1912292210
Name:CORNER PHARMACY LLC
Entity type:Organization
Organization Name:CORNER PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-536-5845
Mailing Address - Street 1:1701 ALEXANDRIA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3149
Mailing Address - Country:US
Mailing Address - Phone:859-309-1230
Mailing Address - Fax:859-335-9668
Practice Address - Street 1:1701 ALEXANDRIA DR
Practice Address - Street 2:STE C
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3149
Practice Address - Country:US
Practice Address - Phone:859-309-1230
Practice Address - Fax:859-309-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07454333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130843OtherPK