Southside Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

13996 Issued in SC

Legal business name

SOUTHSIDE PHARMACY LLC

Doing business as

Southside Pharmacy

Practice address

3320 4TH Ave Ste F
Conway, SC 29527-6057

Phone

(843) 248-6550

Fax

(843) 248-6553

NPI assigned

May 22, 2012

Last updated

Jan 17, 2014By 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

Johnny CappsNPI 1770845034

Title

President/Pharmacist in Charge

Phone

(843) 248-6550

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Southside Pharmacy Doing business as

Locations

Practitioners 2

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.

• Johnny Ray Capps, RPH

  • Pharmacist
  • Conway, SC
  • NPI 1770845034
  NPD (past) Authorized official
• Traci S Powers, PHARMD

  • Pharmacist
  • Conway, SC
  • NPI 1992173512
  NPD (past)

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1104186212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 4TH AVE STE F",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295276057",
            "telephone_number": "843-248-6550",
            "fax_number": "843-248-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 4TH AVE STE F",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295276057",
            "telephone_number": "843-248-6550",
            "fax_number": "843-248-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "CAPPS",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "843-248-6550"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "13996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135319",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71399D",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Carolina Retina Institute LLC
• Southern Oak Dental Conway, LLC
• Southern Oak Dental, LLC
• Southern Urgent Transport LLC
• Southmed Services, LLC
• Sparrow Dental LLC
• Tammy Spencer, MS PSYCHOLOGY
• Elisa Sperduto, LMSW
• Kay J. Spires, R.PH.
• Andrea Spivey

• Community/Retail Pharmacy in Conway, SC
• Providers in Conway, SC by specialty
• Community/Retail Pharmacy in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; 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.