Provider Demographics
NPI:1558850545
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:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:DANNIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMOS FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-844-3455
Mailing Address - Street 1:10555 S EWING AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6200
Mailing Address - Country:US
Mailing Address - Phone:773-902-2356
Mailing Address - Fax:773-902-2458
Practice Address - Street 1:10555 S EWING AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6200
Practice Address - Country:US
Practice Address - Phone:773-902-2356
Practice Address - Fax:773-902-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0208153336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177600OtherPK