Eastside Pharmacy Services, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

EASTSIDE PHARMACY SERVICES, LLC

Doing business as

Banner Drug of Troutman

Practice address

106 Wagner St
Troutman, NC 28166-9627

Phone

(704) 528-6611

NPI assigned

Jul 2, 2019

Last updated

Jul 2, 2019By 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

Melinda C ChildressNPI 1609830025

Title

Owner

Phone

(704) 878-6681

Specialties & licenses 1

Addresses

Other names 1

• Banner Drug of Troutman Doing business as

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.

• Melinda C Childress, PHARMD, MBA

  • Pharmacist
  • Statesville, NC
  • NPI 1609830025
  Authorized official Same address or phone

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1629630348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3478 E BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 WAGNER ST",
            "city": "TROUTMAN",
            "state": "NC",
            "postal_code": "281669627",
            "telephone_number": "704-528-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE PHARMACY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-02",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "CHILDRESS",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-878-6681"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Drug of Troutman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Davenport
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• Kristy Dobbins, LCSWA
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• Kurt Floto, NRP
• Catherine Willeford Forquer, MSSW, LCSW
• Yvonne Brown Foster, CCC SLP
• Barbara Franklin

• Community/Retail Pharmacy in Troutman, NC
• Providers in Troutman, 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 Jul 2, 2019; 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.