Provider Demographics
NPI:1912421272
Name:CORNER DRUG LLC
Entity Type:Organization
Organization Name:CORNER DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:678-485-5145
Mailing Address - Street 1:4 N HIGHLAND ST STE B
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2024
Mailing Address - Country:US
Mailing Address - Phone:859-744-6844
Mailing Address - Fax:859-744-2963
Practice Address - Street 1:4 N HIGHLAND ST STE B
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2024
Practice Address - Country:US
Practice Address - Phone:859-744-6844
Practice Address - Fax:859-744-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP078483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1836165OtherNCPDP