Organization
PPG STORE 1 LLC
Active
Other names
Cornerstone Pharmacy Mansfield
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH HOLDERFIELD RPH (PARTNER, RPH, AO)
(870) 814-0605
Entity
Organization
Contact information
Practice address
607 HIGHWAY 71 E STE B, MANSFIELD, AR 72944-3709
(479) 269-6161
(479) 269-6052
Mailing address
PO BOX 8070, FAYETTEVILLE, AR 72703-0001
(870) 814-0605
(888) 861-0863
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20830
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158060
PK
—
Enumeration date
02/04/2016
Last updated
03/09/2016
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