NPIMap

Organization Active NPI

Cornerstone Pharmacy JFK LLC

  • Community/Retail Pharmacy
  • North Little Rock, AR
National Provider Identifier
1104179274
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
AR20689 Issued in AR
Legal business name
CORNERSTONE PHARMACY JFK LLC
Doing business as
Cornerstone Pharmacy JFK, LLC
Practice address
5328 John F Kennedy Blvd
North Little Rock, AR 72116-6704
Phone
(501) 246-5035
Fax
(501) 246-5448
NPI assigned
Oct 25, 2012
Last updated
Feb 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny HarrisonNPI 1952506081
Title
Partner/Owner
Phone
(501) 580-1895

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X AR20689 AR Primary

Addresses

Primary practice location

5328 John F Kennedy Blvd
North Little Rock, AR 72116-6704

Mailing address

5328 JFK Blvd
North Little Rock, AR 72116-6704
Phone (501) 246-5035

Other identifiers 2

IdentifierTypeStateIssuer
2136806OtherPK
196600407MedicaidAR

Other names 1

  • Cornerstone Pharmacy JFK, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170113001393 AR Part B Supplier - Mass Immunization (Roster Biller Only) 7719269497 Practice locations: North Little Rock, AR
O20250528000207 AR Part B Supplier - Pharmacy 7719269497 1 other NPI on this enrollment
Practice locations: North Little Rock, AR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cornerstone Pharm JFK LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1104179274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5328 JFK BLVD",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721166704",
            "telephone_number": "501-246-5035",
            "fax_number": "501-246-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5328 JOHN F KENNEDY BLVD",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721166704",
            "telephone_number": "501-246-5035",
            "fax_number": "501-246-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE PHARMACY JFK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "PARTNER/OWNER",
        "authorized_official_telephone_number": "501-580-1895"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136806",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196600407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Pharmacy JFK, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.