Healthcare Provider Details

I. General information

NPI: 1740147420
Provider Name (Legal Business Name): CORNERSTONE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 WASHINGTON ST
CLYDE KS
66938
US

IV. Provider business mailing address

1015 TOBIAS DR
LYONS KS
67554-3515
US

V. Phone/Fax

Practice location:
  • Phone: 620-877-7591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACOB EDWARDS
Title or Position: PHARMACIST
Credential:
Phone: 620-877-7591