Provider Demographics
NPI:1841561453
Name:RX CORNER ENTERPRISES LLC
Entity type:Organization
Organization Name:RX CORNER ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-225-7935
Mailing Address - Street 1:98 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1529
Mailing Address - Country:US
Mailing Address - Phone:229-336-2255
Mailing Address - Fax:229-336-2257
Practice Address - Street 1:98 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1529
Practice Address - Country:US
Practice Address - Phone:229-336-2255
Practice Address - Fax:229-336-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0098003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133504OtherPK
GA003120020AMedicaid