Provider Demographics
NPI:1407487390
Name:CORNERSTONE PHARMACY, LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY, LLC
Other - Org Name:CORNERSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:731-614-4259
Mailing Address - Street 1:148 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351
Mailing Address - Country:US
Mailing Address - Phone:731-968-4201
Mailing Address - Fax:731-967-5222
Practice Address - Street 1:1330 US HWY 45 N STE D
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340
Practice Address - Country:US
Practice Address - Phone:731-520-3784
Practice Address - Fax:731-520-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy