Provider Demographics
NPI:1467934810
Name:CORNERSTONE ALLIANCE, LLC
Entity Type:Organization
Organization Name:CORNERSTONE ALLIANCE, LLC
Other - Org Name:LAKE MURRAY DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-622-9976
Mailing Address - Street 1:105 SNAPDRAGON COURT SUITE A
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036
Mailing Address - Country:US
Mailing Address - Phone:803-345-9999
Mailing Address - Fax:
Practice Address - Street 1:105 SNAPDRAGON COURT SUITE A
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-345-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC181363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy