Southside Prof Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SOUTHSIDE PROF PHARMACY INC

Practice address

1408 Bland St
Bluefield, WV 24701-3746

Phone

(304) 327-5600

Fax

(304) 323-1609

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Susie Stauffer

Title

Pic

Phone

(304) 327-5600

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1326145160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 BLAND ST",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 BLAND ST",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013746",
            "telephone_number": "304-327-5600",
            "fax_number": "304-323-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PROF PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "STAUFFER",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "304-327-5600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "SP0550262",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5001463",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelliann Smith
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• Bonnie Crystal Sparks
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• St. Luke'S Hospital
• St. Luke'S Princeton LLC

• Community/Retail Pharmacy in Bluefield, WV
• Providers in Bluefield, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.