Provider Demographics
NPI:1629377742
Name:CORNERSTONE SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:CORNERSTONE SPECIALTY PHARMACY LLC
Other - Org Name:CORNERSTONE SPECIALTY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:479-444-7200
Mailing Address - Street 1:1450 E ZION RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4988
Mailing Address - Country:US
Mailing Address - Phone:479-444-7200
Mailing Address - Fax:479-444-7205
Practice Address - Street 1:1450 E ZION RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4988
Practice Address - Country:US
Practice Address - Phone:479-444-7200
Practice Address - Fax:479-444-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR206453336C0003X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190028407Medicaid
AR201829716Medicaid
2129471OtherPK
2129471OtherPK