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General NPI Number Information
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NPI Number | 1962704775
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Entity Type | Organization
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Legal Business Name | SPECIALTY PHARMACY-SOUTHERN PINES LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 735 S. BENNETT ST.
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City | SOUTHERN PINES
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State | NC
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Zip | 28387
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Country | US
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Telephone | 910-246-9355
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Fax | 910-246-1755
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Provider Business Mailing Address
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Address Line | 735 S BENNETT ST
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-5921
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Country | US
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Telephone | 910-246-9355
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Fax | 910-246-1755
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Authorized Official
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Title or Position | PRESIDENT
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Name | WESLEY WATERS
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Credential |
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Telephone | 910-691-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10686
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License Number State | NC
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