NPIMap

Organization Active NPI

Southern Pines Prescription Shop Inc

  • Community/Retail Pharmacy
  • Robbins, NC
National Provider Identifier
1164560009
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
10391 Issued in 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
Last updated
May 31, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 10391 NC Primary

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 2

IdentifierTypeStateIssuer
2123091OtherPK
1164560009MedicaidNC

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
This NPI is an additional NPI on the 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
Tax ID family
Prescription Shoppe3 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.

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": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1164560009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S MIDDLETON ST",
            "address_2": "P.O. BOX 548",
            "city": "ROBBINS",
            "state": "NC",
            "postal_code": "273258407",
            "telephone_number": "910-948-2921",
            "fax_number": "910-948-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MIDDLETON ST",
            "city": "ROBBINS",
            "state": "NC",
            "postal_code": "27325",
            "telephone_number": "910-948-2921",
            "fax_number": "910-948-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES PRESCRIPTION SHOP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2018-05-31",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123091",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164560009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Robbins, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; 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.