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General NPI Number Information
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NPI Number | 1659512879
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Entity Type | Organization
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Legal Business Name | STANLEYVILLE FAMILY PHARMACY INC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 475 SUMMIT SQUARE BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27105-1485
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Country | US
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Telephone | 336-377-3979
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Fax | 336-377-9979
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Provider Business Mailing Address
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Address Line | 475 SUMMIT SQUARE BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27105-1485
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Country | US
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Telephone | 336-377-3979
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Fax | 336-377-9979
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID PRICE
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Credential |
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Telephone | 336-377-3979
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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 | 10263
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License Number State | NC
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