Healthcare Provider Details

I. General information

NPI: 1205161148
Provider Name (Legal Business Name): SOUTHMONT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10599 NC HIGHWAY 8
LEXINGTON NC
27292-6891
US

IV. Provider business mailing address

10599 NC HIGHWAY 8
LEXINGTON NC
27292-6891
US

V. Phone/Fax

Practice location:
  • Phone: 336-798-1700
  • Fax:
Mailing address:
  • Phone: 336-798-1700
  • Fax: 336-798-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10358
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BILL DAWSON
Title or Position: PHARMACIST
Credential: RPH
Phone: 336-268-1556