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Organization
THE CORNER DRUGSTORE INC
Active
Organization
THE CORNER DRUGSTORE INC
Active
Other names
STANDARD DRUG #10
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD W ROBERTS RPH (PRESIDENT)
(636) 946-6557
Entity
Organization
Contact information
Practice address
1251 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3749
(636) 887-4399
(636) 887-4371
Mailing address
1251 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3749
(636) 887-4399
(636) 887-4371
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
042894
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11478594
STATE TAX ID
MO
01
—
2006035983
STATE LICENSE
MO
Enumeration date
11/17/2006
Last updated
04/18/2008
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