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General NPI Number Information
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NPI Number | 1609573815
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PHARMACY JACKSONVILLE LLC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 315 S JAMES ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4315
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Country | US
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Telephone | 501-983-4249
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S JAMES ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4315
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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 | OWNER
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Name | KENNY HARRISON
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Credential |
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Telephone | 501-580-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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