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General NPI Number Information
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NPI Number | 1659448371
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Entity Type | Organization
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Legal Business Name | SOUTHERN PINES PRESCRIPTION SHOPPE
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1902 N SANDHILLS BLVD STE B
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City | ABERDEEN
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State | NC
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Zip | 28315-2347
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Country | US
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Telephone | 910-692-7467
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 N SANDHILLS BLVD STE B
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City | ABERDEEN
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State | NC
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Zip | 28315-2347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JON PATRICK MCCLAIN
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Credential |
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Telephone | 910-692-7467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07585
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License Number State | NC
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