Southern Pines Prescription Shop Inc
Organization Active NPI Community/Retail Pharmacy · Robbins, NC
NPI 1164560009 · NPPES record last updated May 31, 2018
Key facts
- NPI
- 1164560009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 10391 (NC)
- Legal business name
- SOUTHERN PINES PRESCRIPTION SHOP INC
- Practice address
- 300 Middleton St
Robbins, NC 27325 - Phone
- (910) 948-2921
- Fax
- (910) 948-3477
- NPI assigned
- Feb 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Jon McClain
- Title
- President
- Phone
- (910) 315-4445
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100222000699 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 0446394936 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Robbins, NC |
National Provider Directory
- Tax ID family
- Prescription Shoppe
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 10391 | NC | Yes |
Addresses
Primary practice location
300 Middleton St
Robbins, NC 27325
Mailing address
300 S Middleton St
P.O. Box 548
Robbins, NC 27325-8407
Phone (910) 948-2921
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2123091 | Other | PK | |
| 1164560009 | Medicaid | NC |
Other providers in Robbins, NC
- Peridot Consulting and Treatment Solutions PLLC
- Darrell Lee Powers
- Productive Play Inc.
- Vonda Reives
- Robbins Family Practice, PC
- Deena Page Walters Mauldin
- P. Neil Ward
- Patricia Susan Wright
- Micah Wyatt
All providers in Robbins, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.