Organization
THE CORNER DRUGSTORE INC
Active
Other names
STANDARD DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD ROBERTS RPH CF (PRESIDENT)
(636) 946-6557
Entity
Organization
Contact information
Practice address
3110 W CLAY ST, SAINT CHARLES, MO 63301-1022
(636) 946-3866
(636) 724-1451
Mailing address
3110 W CLAY ST, SAINT CHARLES, MO 63301-1022
(636) 946-3866
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
004712
MO
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601359
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
04/18/2008
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