Provider Demographics
NPI:1881296366
Name:HEALTH CORNER PHARMACY LLC
Entity type:Organization
Organization Name:HEALTH CORNER PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AVERIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD-SYLVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-346-8743
Mailing Address - Street 1:30417 5TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2508
Mailing Address - Country:US
Mailing Address - Phone:281-346-8743
Mailing Address - Fax:346-707-8125
Practice Address - Street 1:30417 5TH ST STE C
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-2508
Practice Address - Country:US
Practice Address - Phone:281-346-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy