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Organization
EASTSIDE PHARMACY SERVICES LLC
Active
Organization
EASTSIDE PHARMACY SERVICES LLC
Active
Other names
Banner Drug Co
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA CHILDRESS (OWNER)
(704) 872-2604
Entity
Organization
Contact information
Practice address
308A MOCKSVILLE HWY, STATESVILLE, NC 28625-8267
(704) 878-6681
(704) 878-6684
Mailing address
308A MOCKSVILLE HWY, STATESVILLE, NC 28625-8267
(704) 878-6681
(704) 878-6684
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
13145
NC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166909
PK
—
Enumeration date
10/24/2016
Last updated
08/28/2023
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