NPIMap

Organization Active NPI

Southern Pines Prescription Shop Inc

Doing business as Peak City Pharmacy

  • Community/Retail Pharmacy
  • Apex, NC
National Provider Identifier
1093949844
Registry record updated May 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
10278 Issued in NC
Legal business name
SOUTHERN PINES PRESCRIPTION SHOP INC
Doing business as
Peak City Pharmacy
Practice address
201 N Salem St
Apex, NC 27502-1429
Phone
(919) 362-4444
Fax
(919) 362-4439
NPI assigned
May 8, 2009
Last updated
May 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2009

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

Authorized official

Name
Jon McClainNPI 1831428820
Title
President
Phone
(910) 315-4445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 10278 NC Primary

Addresses

Primary practice location

201 N Salem St
Apex, NC 27502-1429

Mailing address

110 Mitchell Rd
Southern Pines, NC 28387-6821

Other identifiers 1

IdentifierTypeStateIssuer
3414783OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Peak City Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100222000699 NC Part B Supplier - Mass Immunization (Roster Biller Only) 0446394936 3 other NPIs on this enrollment
Practice locations: Robbins, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1093949844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MITCHELL RD",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283876821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N SALEM ST",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275021429",
            "telephone_number": "919-362-4444",
            "fax_number": "919-362-4439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES PRESCRIPTION SHOP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-08",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "MCCLAIN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-315-4445"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3414783",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak City Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Apex, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; 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.