Kernersville Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

10521 Issued in NC

Legal business name

KERNERSVILLE PHARMACY LLC

Doing business as

Kernersville Pharmacy

Practice address

841 Old Winston Rd Ste 90
Kernersville, NC 27284-7145

Phone

(336) 497-4511

Fax

(336) 497-4511

NPI assigned

May 12, 2010

Organization subpart

No

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

Authorized official

Name

Stanley Watts, BS PHARMACYNPI 1700103892

Title

Officer

Phone

(336) 497-4511

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kernersville Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 3

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

• Stanley Oakley Watts

  • Pharmacist
  • Kernersville, NC
  • NPI 1700103892
  NPD Authorized official
• Kristen Anne Spoon, PHARMD

  • Pharmacist
  • Kernersville, NC
  • NPI 1457911869
  NPD (past)
• Karen Stephenson Watts

  • Pharmacist
  • Kernersville, NC
  • NPI 1861706764
  NPD (past)

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1467770644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 OLD WINSTON RD STE 90",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847145",
            "telephone_number": "336-497-4511",
            "fax_number": "336-497-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 OLD WINSTON RD STE 90",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847145",
            "telephone_number": "336-497-4511",
            "fax_number": "336-497-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERNERSVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "336-497-4511",
        "authorized_official_credential": "BS PHARMACY"
    },
    "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": "10521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124794",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0347780",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kernersville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Kernersville, NC
• Providers in Kernersville, 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 Apr 12, 2017; 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.