1538243811 NPI number — CORNER TECH, INC DBA CAMARGO DRUG COMPANY

Table of content: (NPI 1538243811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538243811 NPI number — CORNER TECH, INC DBA CAMARGO DRUG COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNER TECH, INC DBA CAMARGO DRUG COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAMARGO PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538243811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 PORTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATLETTSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-209-9351
Provider Business Mailing Address Fax Number:
502-780-5896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3404 CAMARGO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-497-0009
Provider Business Practice Location Address Fax Number:
859-497-0046
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOTSON
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
606-255-3154

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07409 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1827661 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".