Provider Demographics
NPI:1689927782
Name:CORNERSTONE PHARMACY LAKEWOOD, LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY LAKEWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
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:501-580-1895
Mailing Address - Street 1:2609 MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8013
Mailing Address - Country:US
Mailing Address - Phone:501-353-1984
Mailing Address - Fax:501-353-2698
Practice Address - Street 1:2609 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8013
Practice Address - Country:US
Practice Address - Phone:501-223-2224
Practice Address - Fax:501-830-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy