Southside Pharmacy

LBN: Southside Pharmacy Llc
Southside Pharmacy is an health care organization with primary practice located at 3320 4Th Ave Ste F , Conway SC 29527-6057. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Southside Pharmacy Llc can be contacted via phone (843) 248-6550, or through Capps, Johnny via phone (843) 248-6550.

Contact Information

Primary practice address
3320 4Th Ave Ste F Conway SC 29527-6057
Phone: (843) 248-6550
Fax: (843) 248-6553
Website:
Map and Directions
Authorized official contact:
Name: Capps, Johnny
Phone: (843) 248-6550

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 13996 South Carolina

Profile Details

NPI number 1104186212
LBN Legal business name Southside Pharmacy Llc
DBA Doing business as Southside Pharmacy
Authorized official Capps, Johnny
Entity Organization
Organization subpart 1 No
Enumeration date May 22nd, 2012
Last updated Jan 17th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104186212 NPPES
Other 2135319 PK
MEDICAID 71399D PK

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