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Organization
YOUR CORNER DRUG STORE LLC
Active
Organization
YOUR CORNER DRUG STORE LLC
Active
Other names
Your Corner Drugstore
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW FRAZIER PHARMD (OWNER)
(478) 254-8484
Entity
Organization
Contact information
Practice address
4260 LOG CABIN DR STE C, MACON, GA 31204-4852
(478) 254-8484
(478) 254-8020
Mailing address
104 LORRAINE FOREST CT, MACON, GA 31210-5316
(478) 994-1189
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010205
GA
3336C0004X
Compounding Pharmacy
—
NULL
Other
Enumeration date
12/18/2015
Last updated
04/19/2017
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