Provider Demographics
NPI:1033487798
Name:SOUTH COURT DRUG CO
Entity Type:Organization
Organization Name:SOUTH COURT DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:TAPSCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPP
Authorized Official - Phone:336-226-4401
Mailing Address - Street 1:210 E ELM ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3055
Mailing Address - Country:US
Mailing Address - Phone:336-226-4401
Mailing Address - Fax:336-228-9996
Practice Address - Street 1:210 E ELM ST STE A
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3055
Practice Address - Country:US
Practice Address - Phone:336-226-4401
Practice Address - Fax:336-228-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0015263Medicaid
NC0015263Medicaid