<Unavail>
LBN: Your Corner Drug Store Llc
<Unavail> is an health care organization with primary practice located at 4260 Log Cabin Dr Ste C , Macon GA 31204-4852. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Your Corner Drug Store Llc can be contacted via phone (478) 254-8484, or through Frazier, Matthew via phone (478) 254-8484.
Contact Information
Primary practice address
4260 Log Cabin Dr Ste C
Macon GA 31204-4852
Phone: (478) 254-8484
Fax: (478) 254-8020
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PHRE010205 | Georgia |
| Suppliers / Compounding Pharmacy | 3336C0004X |
Profile Details
| NPI number | 1629433529 |
|---|---|
| LBN Legal business name | Your Corner Drug Store Llc |
| DBA Doing business as | <Unavail> |
| Authorized official | Frazier, Matthew PHARMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 18th, 2015 |
| Last updated | Apr 19th, 2017 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629433529 | NPPES |
| Other | 2156014 | PK | |
| MEDICAID | 003173406A | PK |
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