Provider Demographics
NPI:1467188029
Name:THE CORNER PHARMACY AND MARKET
Entity type:Organization
Organization Name:THE CORNER PHARMACY AND MARKET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-665-2299
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-0398
Mailing Address - Country:US
Mailing Address - Phone:601-665-2299
Mailing Address - Fax:601-879-7274
Practice Address - Street 1:4835A MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-9691
Practice Address - Country:US
Practice Address - Phone:601-665-2299
Practice Address - Fax:601-879-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000156Medicaid