Provider Demographics
NPI:1992942841
Name:CORNERSTONE PHARMACY LLC
Entity type:Organization
Organization Name:CORNERSTONE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:JESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-565-3434
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:APPALACHIA
Mailing Address - State:VA
Mailing Address - Zip Code:24216-0469
Mailing Address - Country:US
Mailing Address - Phone:276-565-3434
Mailing Address - Fax:
Practice Address - Street 1:205 KILBOURNE AVENUE
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216
Practice Address - Country:US
Practice Address - Phone:276-565-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6236700002Medicare NSC