Provider Demographics
NPI:1437228756
Name:CORNERSTONE PHARMACY INC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY INC
Other - Org Name:CORNERSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-223-2224
Mailing Address - Street 1:4220 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2453
Mailing Address - Country:US
Mailing Address - Phone:501-223-2224
Mailing Address - Fax:501-219-4663
Practice Address - Street 1:4220 N RODNEY PARHAM
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2453
Practice Address - Country:US
Practice Address - Phone:501-223-2224
Practice Address - Fax:501-219-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR203333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182833407Medicaid
AR5536470001Medicare NSC
AR182833407Medicaid
AR48906Medicare PIN