Organization
SOUTHSIDE PROF PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSIE STAUFFER (PIC)
(304) 327-5600
Entity
Organization
Contact information
Practice address
1408 BLAND ST, BLUEFIELD, WV 24701-3746
(304) 327-5600
(304) 323-1609
Mailing address
1408 BLAND ST, BLUEFIELD, WV 24701-3746
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
SP0550262
WV
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5001463
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
09/11/2025
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