Provider Demographics
NPI:1043919848
Name:CORNERSTONE PHARMACY JFK LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY JFK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRISELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-246-5035
Mailing Address - Street 1:5328 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6704
Mailing Address - Country:US
Mailing Address - Phone:501-246-5035
Mailing Address - Fax:501-246-5448
Practice Address - Street 1:5328 JFK BLVD
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6704
Practice Address - Country:US
Practice Address - Phone:501-246-5035
Practice Address - Fax:501-246-5448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE PHARMACY JFK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196600407Medicaid