Provider Demographics
NPI:1205073020
Name:NORTHSIDE FAMILY PHARMACY INC
Entity type:Organization
Organization Name:NORTHSIDE FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-985-4263
Mailing Address - Street 1:3920 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:BATTLEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27809-9038
Mailing Address - Country:US
Mailing Address - Phone:252-985-4263
Mailing Address - Fax:
Practice Address - Street 1:3920 BISHOP RD
Practice Address - Street 2:
Practice Address - City:BATTLEBORO
Practice Address - State:NC
Practice Address - Zip Code:27809-9038
Practice Address - Country:US
Practice Address - Phone:252-985-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09197OtherNC STATE LICENSE
NC0645483Medicaid
NC5576350001Medicare NSC