# SOUTHSIDE PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Southside Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104186212
- **Authorized official:** JOHNNY CAPPS (PRESIDENT/PHARMACIST IN CHARGE)
- **Authorized official phone:** (843) 248-6550

## Contact information

- **Practice address:** 3320 4TH AVE STE F, CONWAY, SC 29527-6057
- **Practice address phone:** (843) 248-6550
- **Practice address fax:** (843) 248-6553
- **Mailing address:** 3320 4TH AVE STE F, CONWAY, SC 29527-6057
- **Mailing address phone:** (843) 248-6550
- **Mailing address fax:** (843) 248-6553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 13996 | SC | Yes |

## Other

- **Enumeration date:** 05/22/2012
- **Last updated:** 01/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2135319 | PK | — |
| 05 | — | 71399D | — | SC |