Your Corner Drugstore

LBN: Your Corner Drug Store Llc
Your Corner Drugstore 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
Fax: (478) 254-8020
Website:
Authorized official contact:
Name: Frazier, Matthew PHARMD

Health care specialties

SpecialtyCodeLicense #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 Your Corner Drugstore
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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629433529 NPPES
Other 2156014 PK
MEDICAID 003173406A PK

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