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
State | License ID | Taxonomies |
---|---|---|
SC | 18136 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |