Provider Demographics
NPI:1306038724
Name:THE CORNER PHARMACY
Entity Type:Organization
Organization Name:THE CORNER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, JD
Authorized Official - Phone:314-330-5597
Mailing Address - Street 1:4901 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5930
Mailing Address - Country:US
Mailing Address - Phone:469-828-4414
Mailing Address - Fax:469-828-4426
Practice Address - Street 1:4901 KELLER SPRINGS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5930
Practice Address - Country:US
Practice Address - Phone:469-828-4414
Practice Address - Fax:469-828-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25674333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy