Organization
SWOFFORD INC
Active
Other names
SOUTHSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CLONIGER (PHARMACIST MANAGER)
(252) 478-5969
Entity
Organization
Contact information
Practice address
98 DODD ST, SPRING HOPE, NC 27882-9581
(252) 478-5969
(252) 478-2978
Mailing address
PO BOX 189, SPRING HOPE, NC 27882-0189
(252) 478-5969
(252) 478-2978
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
07891
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0645440
—
NC
01
—
2067390
PK
—
05
—
7703795
—
NC
Enumeration date
10/03/2006
Last updated
08/28/2020
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