Provider Demographics
NPI:1538243811
Name:CORNER TECH, INC DBA CAMARGO DRUG COMPANY
Entity type:Organization
Organization Name:CORNER TECH, INC DBA CAMARGO DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-497-0009
Mailing Address - Street 1:1316 PORTER ROAD
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129
Mailing Address - Country:US
Mailing Address - Phone:502-209-9351
Mailing Address - Fax:502-780-5896
Practice Address - Street 1:3404 CAMARGO ROAD
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:859-497-0009
Practice Address - Fax:859-497-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP074093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1827661OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1827661OtherNCPDP PROVIDER IDENTIFICATION NUMBER