Provider Demographics
NPI:1306965512
Name:CORNERSTONE PHARMACY AT CHENAL LLC
Entity type:Organization
Organization Name:CORNERSTONE PHARMACY AT CHENAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-821-2300
Mailing Address - Street 1:16115 SAINT VINCENT WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-821-2300
Mailing Address - Fax:501-821-7297
Practice Address - Street 1:16115 SAINT VINCENT WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223
Practice Address - Country:US
Practice Address - Phone:501-821-2300
Practice Address - Fax:501-821-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
ARAR205593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1989790OtherPK
AR163770407Medicaid