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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010205
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003173406A
—
GA
01
—
2156014
PK
—
Enumeration date
12/18/2015
Last updated
04/19/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us