Provider Demographics
NPI:1083834949
Name:SOUTHERN DISCOUNT DRUG, INC.
Entity Type:Organization
Organization Name:SOUTHERN DISCOUNT DRUG, INC.
Other - Org Name:FAMILY DISCOUNT DRUG
Other - Org Type:Doing Business As
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:919-734-6672
Mailing Address - Street 1:1805 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2241
Mailing Address - Country:US
Mailing Address - Phone:919-734-6672
Mailing Address - Fax:919-734-6734
Practice Address - Street 1:1805 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2241
Practice Address - Country:US
Practice Address - Phone:919-734-6672
Practice Address - Fax:919-734-6734
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
NC95273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408324OtherNCPDP NUMBER