Provider Demographics
NPI:1477599850
Name:CORNER DRUG STORES INC
Entity Type:Organization
Organization Name:CORNER DRUG STORES INC
Other - Org Name:CORNER DRUG STORES OF BUNN. BUNN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:919-269-7481
Mailing Address - Street 1:23 EAST HIGHWAY 98
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUNN
Mailing Address - State:NC
Mailing Address - Zip Code:27508
Mailing Address - Country:US
Mailing Address - Phone:919-497-1700
Mailing Address - Fax:919-497-1777
Practice Address - Street 1:23 EAST HIGHWAY 98
Practice Address - Street 2:SUITE 100
Practice Address - City:BUNN
Practice Address - State:NC
Practice Address - Zip Code:27508
Practice Address - Country:US
Practice Address - Phone:919-497-1700
Practice Address - Fax:919-497-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC092063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065497OtherPK
NC1477599850Medicaid