Organization
EASTSIDE PHARMACY SERVICES LLC
Active
Other names
Banner Drug Co
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA CHILDRESS (OWNER)
(704) 872-2604
Entity
Organization
Contact information
Practice address
308A MOCKSVILLE HWY, STATESVILLE, NC 28625-8267
(704) 878-6681
(704) 878-6684
Mailing address
308A MOCKSVILLE HWY, STATESVILLE, NC 28625-8267
(704) 878-6681
(704) 878-6684
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
13145
NC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166909
PK
—
Enumeration date
10/24/2016
Last updated
08/28/2023
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