Provider Demographics
NPI:1447470307
Name:SOUTHERN DISCOUNT DRUG, INC.
Entity type:Organization
Organization Name:SOUTHERN DISCOUNT DRUG, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAIRL
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-378-0830
Mailing Address - Street 1:1050 ALAMANCE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3808
Mailing Address - Country:US
Mailing Address - Phone:336-378-0830
Mailing Address - Fax:336-335-3027
Practice Address - Street 1:1050 ALAMANCE CHURCH RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3808
Practice Address - Country:US
Practice Address - Phone:336-378-0830
Practice Address - Fax:336-335-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408350OtherNCPDP NUMBER