Healthcare Provider Details

I. General information

NPI: 1083161038
Provider Name (Legal Business Name): CORNERSTONE PHARMACY JACKSONVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S JAMES ST
JACKSONVILLE AR
72076-4315
US

IV. Provider business mailing address

315 S JAMES ST
JACKSONVILLE AR
72076-4315
US

V. Phone/Fax

Practice location:
  • Phone: 501-983-4249
  • Fax: 501-983-4643
Mailing address:
  • Phone: 501-983-4249
  • Fax: 501-983-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20848
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: T F KENNETH HARRISON
Title or Position: OWNER/PRESIDENT/AO
Credential:
Phone: 501-580-1895