Provider Demographics
NPI:1316025737
Name:CORNERSTONE DRUG & GIFT INC
Entity Type:Organization
Organization Name:CORNERSTONE DRUG & GIFT INC
Other - Org Name:CORNERSTONE DRUG AND GIFT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-297-3784
Mailing Address - Street 1:72 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUSES POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12979-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72 CHAMPLAIN ST
Practice Address - Street 2:
Practice Address - City:ROUSES POINT
Practice Address - State:NY
Practice Address - Zip Code:12979-1505
Practice Address - Country:US
Practice Address - Phone:518-297-3784
Practice Address - Fax:518-297-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0271293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3343299OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02460251Medicaid
3343299OtherNCPDP PROVIDER IDENTIFICATION NUMBER