Organization
SPECIALTY PHARMACY-SOUTHERN PINES LLC
Active
Other names
Specialty Pharmacy-Southern Pines, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY WATERS (PRESIDENT)
(910) 691-1022
Entity
Organization
Contact information
Practice address
735 S. BENNETT ST., SOUTHERN PINES, NC 28387
(910) 246-9355
(910) 246-1755
Mailing address
735 S BENNETT ST, SOUTHERN PINES, NC 28387-5921
(910) 246-9355
(910) 246-1755
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10686
NC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3458191
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/30/2010
Last updated
03/11/2013
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