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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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