Southern Village Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

11405 Issued in NC

Legal business name

SOUTHERN VILLAGE PHARMACY INC

Doing business as

Southern Village Pharmacy

Practice address

300 Market St
Suite 114
Chapel Hill, NC 27516-4493

Phone

(919) 240-4084

Fax

(919) 724-4568

NPI assigned

Jan 7, 2013

Last updated

Jan 21, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward Gaeton LeakeNPI 1518128677

Title

Owner/Manager

Phone

(919) 240-4084

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Southern Village Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

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.

• Edward Gaeton Leake, R.PH.

  • Pharmacist
  • Chapel Hill, NC
  • NPI 1518128677
  NPD Authorized official
• David L Smithwick

  • Pharmacist
  • Chapel Hill, NC
  • NPI 1225478332
  NPD
• Karson Olivia Guthrie, PHARMD

  • Pharmacist
  • Chapel Hill, NC
  • NPI 1437838521
  NPD (past)
• Rebecca Laney Owings, PHARM.D.

  • Pharmacist
  • Chapel Hill, NC
  • NPI 1255885141
  NPD (past)

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

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1033456371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MARKET ST",
            "address_2": "SUITE 114",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164493",
            "telephone_number": "919-240-4084",
            "fax_number": "919-724-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MARKET ST",
            "address_2": "SUITE 114",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164493",
            "telephone_number": "919-240-4084",
            "fax_number": "919-724-4568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN VILLAGE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "LEAKE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "GAETON",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "919-240-4084"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138555",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0685595",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ayat Rafiq Soufan
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• Ellen Susannah Southern, RD,LDN
• Nathaniel Adam Sowa, MD
• Felicia Soza, NNP
• Melissa Brennen Spacek, NP
• Anna Spagnoli, MD

• Community/Retail Pharmacy in Chapel Hill, NC
• Providers in Chapel Hill, 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 Jan 21, 2025; 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.