MEDICARE: SOUTH COURT DRUG CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	2183	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033487798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COURT DRUG CO

Provider Business Mailing Address
First Line	:	210 E ELM ST STE A
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3055
Country	:	US
Telephone Number	:	336-226-4401
Fax Number	:	336-228-9996

Provider Business Practice Location Address
First Line	:	210 E ELM ST STE A
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3055
Country	:	US
Telephone Number	:	336-226-4401
Fax Number	:	336-228-9996

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM KENT TAPSCOTT
Credential	:	RPH, CPP
Telephone Number	:	336-226-4401

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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Directions to “SOUTH COURT DRUG CO ” Practice Location

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