Your Corner Drug Store LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010205 Issued in GA

Legal business name

YOUR CORNER DRUG STORE LLC

Practice address

4260 Log Cabin Dr Ste C
Macon, GA 31204-4852

Phone

(478) 254-8484

Fax

(478) 254-8020

NPI assigned

Dec 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Frazier, PHARMD

Title

Owner

Phone

(478) 254-8484

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Your Corner Drugstore Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1629433529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LORRAINE FOREST CT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312105316",
            "telephone_number": "478-994-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 LOG CABIN DR STE C",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312044852",
            "telephone_number": "478-254-8484",
            "fax_number": "478-254-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR CORNER DRUG STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-18",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-254-8484",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010205",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2156014",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003173406A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Your Corner Drugstore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Larry David Youngblood III, PT, DPT, ATC, LAT
• Rachel Hinson Youngblood, PA-C
• Mallory Lynn Youngstrom, M.D.
• Abdelmoneim Ibrahim Younis, DVM, PHD
• Albarra Younis
• Your Doctor'S After Hours, LLC
• Ahmed Yousef, PT, PHD
• Marguerite Youssef, PHARMACIST
• Youth Dentistry of Macon, PC
• Youth Development Organization of America

• Community/Retail Pharmacy in Macon, GA
• Providers in Macon, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.