Provider Demographics
NPI:1013008945
Name:SOUTHERN ASSOCIATES OF THE CAROLINAS, INC
Entity Type:Organization
Organization Name:SOUTHERN ASSOCIATES OF THE CAROLINAS, INC
Other - Org Name:SOUTHERN PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-568-9945
Mailing Address - Street 1:4459 TAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:PINK HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28572-9649
Mailing Address - Country:US
Mailing Address - Phone:252-568-9945
Mailing Address - Fax:252-568-3983
Practice Address - Street 1:4459 TAR HILL DR
Practice Address - Street 2:
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572-9649
Practice Address - Country:US
Practice Address - Phone:252-568-9945
Practice Address - Fax:252-568-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082243336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0214000757Medicaid
NC0545608Medicaid
NC0545608Medicaid