NPIMap

Organization Active NPI

Stanleyville Family Pharmacy, Inc

  • Pharmacy
  • Winston Salem, NC
National Provider Identifier
1083997530
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
10263 Issued in NC
Legal business name
STANLEYVILLE FAMILY PHARMACY, INC
Doing business as
Stanleyville Family Pharmacy
Practice address
193 N Summit Square Blvd
Winston Salem, NC 27105
Phone
(336) 377-3979
Fax
(336) 377-9979
NPI assigned
Sep 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

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

Authorized official

Name
Dr. David T Price, PHARMD
Title
President
Phone
(336) 377-3979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 10263 NC Primary

Addresses

Primary practice location

193 N Summit Square Blvd
Winston Salem, NC 27105

Mailing address

193 N Summit Square Blvd
Winston Salem, NC 27105
Phone (336) 377-3979

Other identifiers 1

IdentifierTypeStateIssuer
0347748MedicaidNC

Other names 1

  • Stanleyville Family Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Stanleyville Family Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1083997530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 N SUMMIT SQUARE BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27105",
            "telephone_number": "336-377-3979",
            "fax_number": "336-377-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 N SUMMIT SQUARE BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27105",
            "telephone_number": "336-377-3979",
            "fax_number": "336-377-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLEYVILLE FAMILY PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-21",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-377-3979",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "10263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0347748",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanleyville Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.