Provider Demographics
NPI:1164986188
Name:CORNER DRUG CO. INC.
Entity Type:Organization
Organization Name:CORNER DRUG CO. INC.
Other - Org Name:CORNER DRUG LONG TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-662-2813
Mailing Address - Street 1:PO BOX 1812
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-1812
Mailing Address - Country:US
Mailing Address - Phone:530-662-2813
Mailing Address - Fax:
Practice Address - Street 1:602 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3405
Practice Address - Country:US
Practice Address - Phone:530-662-2813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy