Winston Salem State University

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

12125 Issued in NC

Legal business name

WINSTON SALEM STATE UNIVERSITY

Doing business as

WSSU Wellness Center Pharmacy

Practice address

601 S Martin Luther King Jr Dr
Suite 244
Winston Salem, NC 27110-0003

Phone

(336) 750-3376

NPI assigned

Sep 18, 2014

Last updated

Apr 21, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

WINSTON SALEM STATE UNIVERSITYAs reported in NPPES

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

Authorized official

Name

Beverly Irby

Title

Executive Director

Phone

33675098814

Specialties & licenses 1

Addresses

Other names 1

• WSSU Wellness Center Pharmacy Doing business as

Tax ID family

Winston-Salem State Unive4 organizations share this tax ID, including this one

Part of

Winston-Salem State Unive

Other organizations with this tax ID 3

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

• Winston Salem State University, a. H. Ray Student Health Service

  • Student Health Clinic/Center
  • Winston Salem, NC
  • NPI 1376716811
  NPD tax ID
• Winston-Salem State University

  dba WSSU Sports Medicine

  • Student Health Clinic/Center
  • Winston Salem, NC
  • NPI 1144649948
  NPD tax ID
• Winston-Salem State University

  • Student Health Clinic/Center
  • Winston Salem, NC
  • NPI 1851713374
  NPD tax ID

Locations

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1013319235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S MARTIN LUTHER KING JR DR",
            "address_2": "SUITE 244",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271100003",
            "telephone_number": "336-750-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S MARTIN LUTHER KING JR DR",
            "address_2": "SUITE 244",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271100003",
            "telephone_number": "336-750-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON SALEM STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINSTON SALEM STATE UNIVERSITY",
        "enumeration_date": "2014-09-18",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "IRBY",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "33675098814"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "12125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WSSU Wellness Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Winston Salem Healthcare LLC (Grace Healthcare of Winston Salem)
• Winston Salem Holdings LLC (Reynolds House)
• Winston Salem Industries for the Blind
• Winston Salem Optometric Group PA (C distinctive eyewear)
• Winston Salem Rehab Operations LLC
• Winston Salem State University, a. H. Ray Student Health Service
• Winston Salem Womancare II LLC
• Winston-Salem Chiropractic, Inc
• Winston-Salem Forysth County Schools
• Winston-Salem Opco, LLC (Southfork)

• Community/Retail Pharmacy in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Community/Retail Pharmacy in North Carolina

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

Verify at the official NPI Registry.