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Contact Information

CORNER DRUG STORE
1123 WASHINGTON ST
VICKSBURG, MS39183-2959
 Phone: 601-636-2756
 Fax: 601-638-0071
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
Indicates primary specialty

NPI Profile & details for CORNER DRUG STORE

NPI # 1922031392
LBN Legal business name CORNER DRUG STORE
Authorized official JOSEPH GERACHE - (PHARMACIST)
Entity Organization
Organization subpart 1 No
Enumeration date 07/09/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MS License # 00274
MS Medicaid 00031101
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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