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Organization
CORNER DRUG STORE
Active
Organization
CORNER DRUG STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH A GERACHE JR. (PHARMACIST)
(601) 636-2756
Entity
Organization
Contact information
Practice address
1123 WASHINGTON ST, VICKSBURG, MS 39183-2959
(601) 636-2756
(601) 638-0071
Mailing address
1123 WASHINGTON ST, VICKSBURG, MS 39183-2959
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
00274
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00031101
—
MS
Enumeration date
07/09/2006
Last updated
08/22/2020
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