Organization
PPG STORE 2 LLC
Active
Other names
Cornerstone Pharmacy Gentry
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH HOLDERFIELD (OWNER, PIC, AO)
(870) 814-0605
Entity
Organization
Contact information
Practice address
560 GENTRY BLVD, GENTRY, AR 72734-8576
(479) 525-6200
(479) 525-6168
Mailing address
PO BOX 8070, FAYETTEVILLE, AR 72703-0001
(479) 525-6200
(888) 861-0863
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20833
AR
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158041
PK
—
Enumeration date
02/17/2016
Last updated
03/31/2016
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