Provider Demographics
NPI:1265461040
Name:CORNER DRUG WINCHESTER INC
Entity Type:Organization
Organization Name:CORNER DRUG WINCHESTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:HORN
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-744-6844
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-0220
Mailing Address - Country:US
Mailing Address - Phone:859-744-6844
Mailing Address - Fax:859-744-2963
Practice Address - Street 1:4 N HIGHLAND ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2024
Practice Address - Country:US
Practice Address - Phone:859-744-6844
Practice Address - Fax:859-744-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90011511332B00000X
KYP069633336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54007950Medicaid
KY90011511Medicaid
KYP06963OtherPHARMACY LICENSES
KYP06963OtherPHARMACY LICENSES