NPIMap

Organization Active NPI

Eastside Pharmacy Services, LLC

  • Long Term Care Pharmacy
  • Statesville, NC
National Provider Identifier
1134719628
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
EASTSIDE PHARMACY SERVICES, LLC
Practice address
308A Mocksville Hwy
Statesville, NC 28625-8267
Phone
(704) 878-6681
NPI assigned
Jan 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Melinda C Childress
Title
Owner
Phone
(704) 878-6681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

308A Mocksville Hwy
Statesville, NC 28625-8267

Mailing address

308A Mocksville Hwy
Statesville, NC 28625-8267

Other names 1

  • Banner Drug LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Banner Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1611014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1134719628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308A MOCKSVILLE HWY",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308A MOCKSVILLE HWY",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258267",
            "telephone_number": "704-878-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE PHARMACY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-19",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "CHILDRESS",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-878-6681"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Drug LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.