Organization
ASKK LLC
Active
Other names
SOUTHSIDE DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTTIE BRYAN FREEMAN (PRESIDENT)
(336) 830-8774
Entity
Organization
Contact information
Practice address
3085 WAUGHTOWN ST, WINSTON SALEM, NC 27107-1634
(336) 830-8774
(336) 830-8775
Mailing address
3085 WAUGHTOWN ST, WINSTON SALEM, NC 27107-1634
(336) 830-8774
(336) 830-8775
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
11987
NC
332BC3200X
Customized Equipment (DME)
11987
NC
3336C0003X
Community/Retail Pharmacy
Primary
11987
NC
3336C0004X
Compounding Pharmacy
11987
NC
Other
Enumeration date
04/15/2014
Last updated
09/05/2015
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