| NPI | 1134548415 |
|---|---|
| Doing Business As | SOUTHSIDE DISCOUNT PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SCOTTIE BRYAN FREEMAN President 336-830-8774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NC 11987) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 11987) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NC 11987) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NC 11987) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2015-09-05 |