Guardian Pharmacy of Eastern NC, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

10966 Issued in NC

Legal business name

GUARDIAN PHARMACY OF EASTERN NC, LLC

Doing business as

Southern Pharmacy Services

Practice address

4459 Tarheel Dr
Pink Hill, NC 28572-9649

Phone

(252) 568-9945

Fax

(866) 928-3983

NPI assigned

Mar 30, 2011

Organization subpart

No

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

Authorized official

Name

Chad Terry

Title

Co-President

Phone

(866) 768-8479

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Southern Pharmacy Services Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Guardian Pharmacy of Eastern NC, LLC

  dba Southern Pharmacy Services Winston-Salem

  • Long Term Care Pharmacy
  • Kernersville, NC
  • NPI 1730478827

  5496903205

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Guardian Pharmacy of Eastern NC, LLC

  dba Southern Pharmacy Services Winston-Salem

  • Long Term Care Pharmacy
  • Kernersville, NC
  • NPI 1730478827

  O20121212000408

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Moravian Home Incorporated

  dba Salemtowne

  • Skilled Nursing Facility
  • Winston Salem, NC
  • NPI 1568454262

  Adp of the SNF

  CMS ownership

Practitioners 3

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.

• Cecil Manning Davis, PHARM.D

  • Geriatric Pharmacist
  • Kernersville, NC
  • NPI 1104029602
  NPD (past)
• Candace Dufour, PHARMD

  • Pharmacist
  • Kernersville, NC
  • NPI 1417604646
  NPD (past)
• Kimberly Carroll Ward

  • Geriatric Pharmacist
  • Kernersville, NC
  • NPI 1851035257
  NPD (past)

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1821387911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT # 2435 GUARDIAN PHARMACY OF EASTERN NC",
            "address_2": "P.O. BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352460001",
            "telephone_number": "404-810-0089",
            "fax_number": "404-810-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4459 TARHEEL DR",
            "city": "PINK HILL",
            "state": "NC",
            "postal_code": "285729649",
            "telephone_number": "252-568-9945",
            "fax_number": "866-928-3983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF EASTERN NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-30",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "866-768-8479"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NC",
            "license": "10966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130223",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821387911",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821387911",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7N0965",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pharmacy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chrystal T. Rooks, DDS, PA
• Stephanie Grainger Ellis, RPH
• Bonnie Gail Flora, LMBT
• Heather Garcia Cruz
• Glencare Assisted Living, Inc.
• Taylor Hawkins
• Heritage Creek Family Care Estate
• Libby Annette Holley, RN
• Jordyn Jackson
• Rhonda Mizelle Jones, PT

• Long Term Care Pharmacy in Pink Hill, NC
• Providers in Pink Hill, NC by specialty
• Long Term Care Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.