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General NPI Number Information
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NPI Number | 1588077283
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PHARMACY CONWAY, LLC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 815 HOGAN LN STE 10
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City | CONWAY
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State | AR
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Zip | 72034-7959
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Country | US
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Telephone | 501-328-3282
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Fax |
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Provider Business Mailing Address
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Address Line | 815 HOGAN LN STE 10
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City | CONWAY
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State | AR
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Zip | 72034-7959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/OWNER
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Name | JOHN G WIRGES IV
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Credential |
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Telephone | 501-328-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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