Provider Demographics
NPI:1346468089
Name:CORNERSTONE PHARMACY, LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-686-0006
Mailing Address - Street 1:2511 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8463
Mailing Address - Country:US
Mailing Address - Phone:956-686-0006
Mailing Address - Fax:956-686-3339
Practice Address - Street 1:2511 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8463
Practice Address - Country:US
Practice Address - Phone:956-686-0006
Practice Address - Fax:956-686-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24151332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016729803Medicaid
TX016729804Medicaid
TX016729803Medicaid