# YOUR CORNER DRUG STORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Your Corner Drugstore
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629433529
- **Authorized official:** MATTHEW FRAZIER PHARMD (OWNER)
- **Authorized official phone:** (478) 254-8484

## Contact information

- **Practice address:** 4260 LOG CABIN DR STE C, MACON, GA 31204-4852
- **Practice address phone:** (478) 254-8484
- **Practice address fax:** (478) 254-8020
- **Mailing address:** 104 LORRAINE FOREST CT, MACON, GA 31210-5316
- **Mailing address phone:** (478) 994-1189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE010205 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/18/2015
- **Last updated:** 04/19/2017