South Park Family Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SOUTH PARK FAMILY PHARMACY LLC

Practice address

1215 A West Clemmonsville Road
Winston-Salem, NC 27127-4790

Phone

(336) 853-2744

Fax

(336) 853-5915

NPI assigned

Jun 10, 2013

Organization subpart

No

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

Authorized official

Name

Russell Warren Patterson, PHARM D.

Title

Member/Manager

Phone

(336) 817-6794

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• South Park Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Chirstopher Council Jr.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Winston Salem, NC
  • NPI 1669897088
  NPD (past)
• Brittany Lyda, PHARMD

  • Pharmacist
  • Winston Salem, NC
  • NPI 1962160697
  NPD (past)

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781740800000",
    "number": "1295173573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 W MARKET CENTER DR",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272601642",
            "telephone_number": "336-817-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 A WEST CLEMMONSVILLE ROAD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271274790",
            "telephone_number": "336-853-2744",
            "fax_number": "336-853-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-10",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "336-817-6794",
        "authorized_official_credential": "PHARM D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "11570",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295173573",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Park Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Park Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Mark Sorscher, MD
• Mary O Sotile, MA, LPC
• Wayne M Sotile, PH.D.
• Elizabeth Joan Soto, PA
• Candice Rae Sotriffer, M.A. ED.S LPC
• John K Southard Jr., M.D.
• Monica Espinoza Southard, MA BCBA
• Southerland Treatment and Rehab(Star) Counseling&Consulting SVCS, PLLC
• Timeka A Southerland, LPC
• Southern Assisted Living, LLC.

• Community/Retail Pharmacy in Winston-Salem, NC
• Providers in Winston-Salem, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; 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.