Healthcare Provider Details

I. General information

NPI: 1609936897
Provider Name (Legal Business Name): CORNERSTONE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 E STATE ROUTE 72
ROLLA MO
65401-3938
US

IV. Provider business mailing address

1216 E STATE ROUTE 72
ROLLA MO
65401-3938
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-5700
  • Fax:
Mailing address:
  • Phone: 573-426-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2001024190
License Number StateMO

VIII. Authorized Official

Name: ERIC RICHARD SANDS
Title or Position: PRESIDENT
Credential: RPH
Phone: 573-426-5700