SOUTHSIDE PHARMACY LLC (NPI# 1104186212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104186212 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE PHARMACY LLC |
| Other Organization Name | SOUTHSIDE PHARMACY |
| Practice Address |
3320 4th Ave Ste F Conway SC 29527-6057 |
| Practice Telephone | 8432486550 |
| Practice Fax Number | 8432486553 |
| Mailing Telephone | 8432486550 |
| Mailing Fax Number | 8432486553 |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2014-01-17 |
| Authorized Official Name | JOHNNY CAPPS (PRESIDENT/PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 8432486550 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
13996 | SC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 71399D | 05 | |
| PK | 2135319 | 01 |
| Other Name | Type Code |
|---|---|
| Southside Pharmacy | Doing Business As Name - Organization |
| Street Address |
3320 4TH AVE STE F |
| City | CONWAY |
| State | SC |
| Zip Code | 29527-6057 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992173512 | Traci S Powers | Pharmacist | 3320 4th Ave Ste F, Conway, SC 29527-6057 | 2015-09-14 |
| 1770845034 | Johnny Ray Capps | Pharmacist | 3320 4th Ave Ste F, Conway, SC 29527-6057 | 2012-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245511435 | Rocky Mountain Holdings LLC | Ambulance | 1700 Airport Road, Conway, SC 29527 | 2011-09-01 |
| 1295946838 | Bonnie Jean Miller | Occupational Therapy Assistant | 3300 4th. Ave., Conway, SC 29527 | 2007-05-25 |
| 1255987269 | Mansi D Patel | In Home Supportive Care | 2408 Westbrook Dr, Conway, SC 29527-3150 | 2019-08-15 |
| 1104862788 | James R Bean | Physician Assistant | 1013 Dunraven Ct, Conway, SC 29527-3154 | 2006-06-21 |
| 1194255315 | Canisha Sharron Rice | Home Health | 1213 Cymmer Ct, Conway, SC 29527-3165 | 2017-06-20 |
| 1578968988 | Pshanda Chante Pugh | Counselor | 1208 Dunraven Ct, Conway, SC 29527-3170 | 2014-10-28 |
| 1205457017 | Heather Melton Lee | Specialist/Technologist | 252 Maidens Choice Rd, Conway, SC 29527-3418 | 2020-05-04 |
| 1093336760 | Chelsea Kamens | Registered Nurse | 357 Shallow Cove Dr, Conway, SC 29527-3458 | 2020-05-04 |
| 1538628193 | Jasmine L Gaddy | Home Health | 728 Rose Moss Rd, Conway, SC 29527-3579 | 2019-03-13 |
| 1801213327 | Tonya Peavy | Registered Nurse | 729 Brown Swamp Rd, Conway, SC 29527-3636 | 2014-03-21 |
| Find all providers in zip 29527 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124672662 | Proxsys Rx - Sc, LLC | Pharmacy | 300 Singelton Ridge Road, Conway, SC 29526 | 2019-08-01 |
| 1023466281 | Sam's Club Pharmacy | Pharmacy | 1850 S Donaghey Ave, Conway, AR 72034-8659 | 2016-05-28 |
| 1588077283 | Cornerstone Pharmacy Conway, LLC | Pharmacy | 815 Hogan Ln Ste 10, Conway, AR 72034-7959 | 2014-06-10 |
| 1659619120 | Conway Medcare Pharmacy, LLC | Pharmacy | 2521 College Ave, Conway, AR 72034-6135 | 2013-01-17 |
| 1881909638 | Harps Food Stores, Inc | Pharmacy | 1120 E German Ln, Conway, AR 72032 | 2010-08-17 |
| 1669619094 | Saint-mark Enterprises 1906 LLC | Pharmacy | 2125 College Ave Ste 1, Conway, AR 72034-6387 | 2009-01-07 |
| 1851494629 | South Carolina Cvs Pharmacy LLC | Pharmacy | 707 Church St, Conway, SC 29526-4824 | 2006-09-07 |
| 1649373135 | South Carolina Cvs Pharmacy LLC | Pharmacy | 2296 Hwy 501 East, Conway, SC 29526 | 2006-09-07 |
| 1316969199 | Arkansas Cvs Pharmacy LLC | Pharmacy | 501 Elsinger Blvd, Conway, AR 72032-4717 | 2006-07-24 |
| 1790306363 | Conway Pharmacy | Pharmacy | 1610 Church St Ste C, Conway, SC 29526-2960 | 2020-05-05 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.