NPIMap

Organization Active NPI

Stanleyville Family Pharmacy Inc

  • Community/Retail Pharmacy
  • Winston Salem, NC
National Provider Identifier
1659512879
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
10263 Issued in NC
Legal business name
STANLEYVILLE FAMILY PHARMACY INC
Doing business as
Stanleyville Family Pharmacy
Practice address
475 Summit Square Blvd
Winston Salem, NC 27105-1485
Phone
(336) 377-3979
Fax
(336) 377-9979
NPI assigned
Mar 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
David Price
Title
Manager
Phone
(336) 377-3979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 10263 NC Primary

Addresses

Primary practice location

475 Summit Square Blvd
Winston Salem, NC 27105-1485

Mailing address

475 Summit Square Blvd
Winston Salem, NC 27105-1485
Phone (336) 377-3979

Other identifiers 1

IdentifierTypeStateIssuer
2119499OtherPK

Other names 1

  • Stanleyville Family Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100628000802 NC Part B Supplier - Mass Immunization (Roster Biller Only) 0648301176 Practice locations: Winston Salem, NC

National Provider Directory

National Provider Directory
Tax ID family
Stanleyville Family Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

475 Summit Square Blvd
Winston Salem, NC 27105
Phone (336) 377-3979

NPI Registry JSON

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

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1659512879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SUMMIT SQUARE BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271051485",
            "telephone_number": "336-377-3979",
            "fax_number": "336-377-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SUMMIT SQUARE BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271051485",
            "telephone_number": "336-377-3979",
            "fax_number": "336-377-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLEYVILLE FAMILY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "336-377-3979"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119499",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanleyville Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.