Healthcare Provider Details

I. General information

NPI: 1992942841
Provider Name (Legal Business Name): CORNERSTONE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 KILBOURNE AVENUE
APPALACHIA VA
24216
US

IV. Provider business mailing address

PO BOX 469
APPALACHIA VA
24216-0469
US

V. Phone/Fax

Practice location:
  • Phone: 276-565-3434
  • Fax:
Mailing address:
  • Phone: 276-565-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD DWIGHT JESSEE
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 276-565-3434