Provider Demographics
NPI:1790139111
Name:CORNERSTONE PHARMACY MAIN LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHARMACY MAIN LLC
Other - Org Name:CORNERSTONE PHARMACY MAIN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:T F KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-223-8450
Mailing Address - Street 1:1701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1471
Mailing Address - Country:US
Mailing Address - Phone:501-246-5451
Mailing Address - Fax:501-400-8917
Practice Address - Street 1:1701 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1471
Practice Address - Country:US
Practice Address - Phone:501-246-5451
Practice Address - Fax:501-414-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR208373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159636OtherPK