Organization
SOUTHSIDE PHARMACY LLC
Active
Other names
Southside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY CAPPS (PRESIDENT/PHARMACIST IN CHARGE)
(843) 248-6550
Entity
Organization
Contact information
Practice address
3320 4TH AVE STE F, CONWAY, SC 29527-6057
(843) 248-6550
(843) 248-6553
Mailing address
3320 4TH AVE STE F, CONWAY, SC 29527-6057
(843) 248-6550
(843) 248-6553
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
13996
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135319
PK
—
05
—
71399D
—
SC
Enumeration date
05/22/2012
Last updated
01/17/2014
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