NPIMap

Organization Active NPI

Kernersville Pharmacy LLC

Doing business as Kernersville Pharmacy

  • Community/Retail Pharmacy
  • Kernersville, NC
National Provider Identifier
1881996114
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
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 27284-7144
Phone
(336) 497-4511
NPI assigned
Nov 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Mr. Stanley Oakley Watts, RPH.NPI 1700103892
Title
Pharmacist
Phone
(336) 497-4511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 10521 NC Primary

Addresses

Primary practice location

841 Old Winston Rd
Ste 90
Kernersville, NC 27284-7144

Mailing address

841 Old Winston Rd
Ste 90
Kernersville, NC 27284-7144
Phone (336) 497-4511

Other identifiers 1

IdentifierTypeStateIssuer
0347780MedicaidNC

Other names 1

  • KERNERSVILLE PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

841 Old Winston Rd
Ste 90
Kernersville, NC 27284
Phone (336) 497-4511

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1881996114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 OLD WINSTON RD",
            "address_2": "STE 90",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847144",
            "telephone_number": "336-497-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 OLD WINSTON RD",
            "address_2": "STE 90",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847144",
            "telephone_number": "336-497-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERNERSVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "OAKLEY",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "336-497-4511",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0347780",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KERNERSVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.