Organization
KERNERSVILLE PHARMACY LLC
Active
Other names
Kernersville Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY WATTS BS PHARMACY (OFFICER)
(336) 497-4511
Entity
Organization
Contact information
Practice address
841 OLD WINSTON RD STE 90, KERNERSVILLE, NC 27284-7145
(336) 497-4511
(336) 497-4511
Mailing address
841 OLD WINSTON RD STE 90, KERNERSVILLE, NC 27284-7145
(336) 497-4511
(336) 497-4511
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10521
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0347780
—
NC
01
—
2124794
PK
—
Enumeration date
05/12/2010
Last updated
04/12/2017
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