Provider Demographics
NPI:1932657608
Name:CORNER MARKET & PHARMACY INC
Entity Type:Organization
Organization Name:CORNER MARKET & PHARMACY INC
Other - Org Name:CORNER MARKET & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:ELNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DARJ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-200-8472
Mailing Address - Street 1:8309 GRUBB RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2539
Mailing Address - Country:US
Mailing Address - Phone:301-200-8472
Mailing Address - Fax:301-710-5319
Practice Address - Street 1:8309 GRUBB RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2539
Practice Address - Country:US
Practice Address - Phone:301-200-8472
Practice Address - Fax:301-710-5319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MDP073773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164138OtherPK