Southside Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

027526 Issued in NY

Legal business name

SOUTHSIDE PHARMACY INC

Doing business as

Southside Pharmacy

Practice address

766 Foote Ave
Jamestown, NY 14701-8201

Phone

(716) 487-0133

Fax

(716) 487-0233

NPI assigned

Mar 15, 2006

Last updated

Apr 10, 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

Salim Sarvaiya, RPHNPI 1669441390

Title

Owner

Phone

(716) 487-0133

Specialties & licenses 2

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.

• Salim Sarvaiya, RPH

  • Pharmacist
  • Jamestown, NY
  • NPI 1669441390
  NPD (past) Authorized official
• Karen T. Gullotti, RPH

  • Pharmacist
  • Jamestown, NY
  • NPI 1114987864
  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1245209956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147018201",
            "telephone_number": "716-487-0133",
            "fax_number": "716-487-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147018201",
            "telephone_number": "716-487-0133",
            "fax_number": "716-487-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "SARVAIYA",
        "authorized_official_first_name": "SALIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-487-0133",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "027526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02712274",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHSIDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.